Assessment of hostility in patients with coronary heart disease

One of the problems in efforts to more clearly conceptualize hostility is the amount of method variance, which ranges from self-report techniques to interview-based methods and mirrors the multidimensional nature of hostility and related constructs. In addition, rather few studies concerned with the assessment of hostility have specifically used samples of coronary heart disease (CHD) patients. The purpose of this study was, therefore, to examine the multidimensionality of the construct of hostility in a sample of male coronary patients with some frequently used instruments. Factor analysis was used to detect the relevant underlying constructs, which were assessed using a variety of hostility measures in a sample of cardiac patients undergoing baseline assessment in an ongoing health-education intervention study. Measurement included both questionnaires and interviews. Participants (N = 235) were divided into 3 diagnostic groups: patients who had recently undergone (a) a myocardial infarction, (b) coronary artery bypass grafting, or (c) percutaneous transluminal coronary angioplasty. A 4-factor solution appeared to provide the best fit, and the following factors were isolated: Anger-Out, Negative Affect, Coping, and Anger-In. All intercorrelations were less than .50. Medical diagnosis did not differ with regard to the 4 factors found. The total hostility construct as measured by the structured interview (SI) did not fit into the 4-factor model. This study was the first to show that dimensions of anger and hostility constitute valid and relevant aspects of the general construct of hostility for a representative group of CHD patients. The 4 aspects of hostility isolated using some well-known hostility questionnaires and the SI explained most of the observed variance. Although the SI appeared to tap more general state anger, the 4 aspects of hostility may be differentially related to health in those who are coronary prone. Future studies on the role of hostile or negative emotions in CHD patients should, therefore, pay greater attention to the multidimensional nature of hostility and may clearly benefit from the use of the 4-factor model described in this article.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

Reliability and validity of a twelve-minute walking test for coronary heart disease patients

This study examined the reliability and validity of a 12-min. walking test for coronary heart disease patients. CHD patients (28 men, 18 women) were recruited out of 86 CHD patients of the Martini Hospital Groningen, The Netherlands. 46 CHD patients (age M=66.0 yr., SD=6.8) participated in the reliability study and 24 (age M=62.0 yr., SD=9.2) in the validity study. A test-retest analysis showed a satisfactory Bland-Altman plot and an intraclass coefficient of .98. The Pearson correlation between the score on the test and the VO2 peak was .77. This test gives a reliable and valid assessment of cardiorespiratory fitness of CHD patients.     

The short-term effects of a hostility-reduction intervention on male coronary heart disease patients.

This preliminary study examined the effects of a hostility-reduction intervention on patients with coronary heart disease (CHD). Twenty-two high-hostile CHD men were matched on age and hostility and then randomly assigned to a hostility intervention (N = 10) or an information-control group (N = 12). Patients were reassessed immediately and 2 months posttreatment on hostility (with self-report and structured interview) and resting blood pressure. The intervention's overall effect size was moderately strong (d' = .62). Intervention patients reported at both reassessments and were observed at follow-up to be less hostile than controls. At follow-up, intervention patients had significantly lower diastolic blood pressure (DBP) than controls. Finally, reductions in hostility were significantly and positively correlated with reductions in DBP. Replication with a larger sample and CHD outcomes is recommended.     

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Abstract

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training.

The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident.

In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation.

These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.     

Association of heart rate and heart-rate variability with scores on the emotion profile index in patients with acute coronary heart disease.

We investigated the link between the eight basic emotions named by Plutchik and heart rate, heart-rate variability in the 114 patients, 86 men and 28 women (M = 53.8 yr., SD = 8.0) with acute coronary heart disease during the initial 24-hr. stay in the coronary care unit and again at hospital discharge. Variability in heart rate was significantly positively associated with scores on Trust (the emotional state acceptance) at hospital admission and discharge in the patients with unstable angina and non-Q-wave infarction, on Aggression in the patients with unstable angina at hospital discharge and at hospital admission in the patients with non-Q-wave infarction. There was inverse relation on Timid (the emotional state fear) and Gregarious (joy) at hospital admission and on Distrust (disgust or rejection), Depressed (sadness), and Dyscontrol (impulsiveness) at hospital discharge in the patient with non-Q-wave infarction. There was no significant association between heart-rate variability and the scores on the Emotion Profile Index in the patients with anterior and posterior myocardial infarction. There was no statistically significant association between heart rate and scores on the Emotion Profile Index in the patients with acute coronary disease at hospital admission and discharge. Our results suggest psychological interventions that enhance emotional states represented by the Trust and Aggression scales and minimize those represented by Depressed, Dyscontrol, Timid, and Distrust scales could have a beneficial effect on cardiovascular function in the patients with unstable angina and non-Q-wave infarction in a hospital setting.     

Hostility, the metabolic syndrome, and incident coronary heart disease.

This invesgation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated though mechanisms other than factors that constitute the metabolic syndrome.     

Anger in type a women: Implications for coronary heart disease

The present study examines the relationship between Type A behaviour and anger in a sample of managerial women. The Type A behaviour pattern is hard driving, job-devoted lifestyle which is associated with a significantly increased risk of coronary heart disease in men as in women. Anger and hostility have been reported to be critical components of the Type A behaviour pattern which contribute to coronary heart disease. This research also examines the relationship between occupational demands and job anger in managerial women. Occupational demands include demands particularly unique to women in non-traditional occupational roles such as inequity of pay, underutilization of skills, low boss support and perceived sex discrimination. State (job) and Trait Anger were also assessed as were various psychological and behavioural outcomes such as state anxiety, depression, job satisfaction, absenteeism, and “intention to turnover”. Results showed that sex discrimination was a significant occupational stressor in Type As only. Further results of a multiple regression analysis indicated tha for Type As only, sex discrimination was positively associated with job anger when social support from one's boss was low. However, with increasing support, Type As were less likely to report anger when discrimination was high. In conclusion, the results of this study have demonstrated that social support can function as a buffer against anger, thus extending the buffering hypothesis originally put forth to refer to the buffering effects of social support and anxiety.     

Validating the Beck Depression Inventory-II in Indonesia's general population and coronary heart disease patients

This study assesses the validity and determines the cut-off point for the Beck Depression Inventory-II (the BDI-II) among Indonesians. The Indonesian version of the BDI-II (the Indo BDI-II) was administered to 720 healthy individuals from the general population, 215 Coronary Heart Disease (CHD) patients, and 102 depressed patients. Confirmatory factor analysis indicated factorial similarity across the three samples. Significant correlations between the Indo BDI-II and other self-report measures related to depression demonstrated construct validity of the Indo BDI-II. Furthermore, there was a highly significant difference in the Indo BDI-II scores between depressed patients and non-depressed participants. Internal consistency and re-test reliability of the Indo BDI-II were acceptable. The receiver operating characteristic (ROC) curve indicated that the cut-off point of the Indo BDI-II for a mild severity of depression in Indonesian population should be 17. We conclude that the Indo BDI-II is a valid measure of depression, both in the Indonesian general population and in CHD patients.     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗.现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述.     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。     

The effectiveness of school-based anger interventions and programs: A meta-analysis

Twenty peer-reviewed journal articles that described outcomes of interventions that took place in school settings and either focused on anger or included anger as a dependent variable were meta-analyzed. No differences in outcomes were found for group comparisons by school setting, special education status, entrance criteria, or treatment agents. Although 60% of articles discussed its importance, only two articles actually measured treatment integrity. Across outcomes, the weighted mean effect size of the interventions post treatment was determined to be .31. The largest effects were found for anger and externalizing behaviors, internalizing, and social skills, with mean effect sizes of .54, .43, and .34 respectively. Weighted mean effect sizes for follow-up studies were also calculated, but given the small number of studies that reported follow-up effects, those must be interpreted with caution. The results of this meta-analysis are discussed as they relate to research, practice, and intervention with children.     

The Myers-Briggs type indicator and coronary heart disease

Researchers have for many years attempted to establish a relationship between coronary heart disease (CHD) and personality type. In our study, 103 subjects completed Form G of the Myers-Briggs Type Indicator (MBTI). Comparisons were made between 93 CHD patients and an age-appropriate control group (Group C) on each of the four MBTI dimensions: Extraversion-Introversion, Sensing-Intuition, Thinking-Feeling, and Judging-Perceiving. The comparison between CHD patients and Group C showed that CHD patients were significantly more likely to prefer sensing and feeling.     

Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients

OBJECTIVE: To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES: The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS: Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION: These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.     

Psychological perspectives on the development of coronary heart disease

Psychological science has new opportunities to have major input into the understanding of the development of coronary heart disease. This article provides an overview of advances in understanding the etiology of heart disease, recently applied technologies for measuring early stages of heart disease, and an accumulating base of evidence on the psychosocial predictors of clinical and subclinical coronary disease. It suggests that it is now time to develop conceptual models that integrate our understanding of separate psychosocial predictors. It offers and provides preliminary evidence for a model that integrates socioeconomic status, environmental stress, and person-level factors from a life span perspective.     

Personality as a risk factor in coronary heart disease

The pioneering work of the authors of the Type A personality concept has now been shown to be seriously flawed, with only the traits of anger, aggression, and hostility remaining as risk factors for coronary heart disease (CHD). There is now evidence for a much stronger relationship between CHD and personality involving a rather different set of concepts and theories. The evidence for such a relationship is summarized, and a causal link suggested. It is also shown that the CHD-prone type of behaviour can be changed by behaviour therapy, decreasing considerably the risk of dying from CHD.     

Applicability of cognitive adaptation theory to predicting adjustment to heart disease after coronary angioplasty.

The purpose of this study was to determine whether cognitive adaptation theory (i.e., cognitively responding to challenges to world assumptions) would predict positive adjustment to heart disease in the face of a recurrent event. Men and women who were treated for a coronary event with percutaneous transluminal coronary angioplasty (N = 278) were interviewed in the hospital and then 6 months later. Indicators of cognitive adaptation theory (self-esteem, optimism, mastery) and adjustment were assessed. In general, cognitive adaptation indicators predicted positive adjustment, sometimes showing stronger relations for those who faced a recurrent event. In addition, patients' cognitions were robust over time, meaning that they were not affected by recurrent events. Patients' beliefs about the angioplasty decision, however, showed differential relations to adjustment, depending on whether they sustained a recurrence.     

School programs targeting stress management in children and adolescents: A meta-analysis

Introduction

This meta-analysis evaluates the effect of school programs targeting stress management or coping skills in school children.

Methods

Articles were selected through a systematic literature search. Only randomized controlled trials or quasi-experimental studies were included. The standardized mean differences (SMDs) between baseline and final measures were computed for experimental and control groups. Experimental groups were groups that either received an intervention of (a) relaxation training, (b) social problem solving, (c) social adjustment and emotional self-control, or (d) a combination of these interventions. If no baseline measurement was available, SMDs were calculated between final measures of the groups. The overall pooled effect size was calculated and the pooled effect sizes of improvement on stress, coping, (social) behavior, and self-efficacy by random effects meta-analysis. The dependence of the results on study characteristics (i.e. methodological quality and type of intervention) was evaluated using meta-regression analysis.

Results

Nineteen publications met the inclusion criteria of controlled trials for class programs, teaching coping skills or stress management. Overall effect size for the programs was − 1.51 [95% confidence interval (CI) − 2.29, − 0.73], indicating a positive effect. However, heterogeneity was significant (p < .001). Sensitivity analyses showed that study quality and type of intervention were sources of heterogeneity influencing the overall result (p values < .001). The heterogeneity in quality may be associated with methodological diversity and differences in outcome assessments, rather than variety in treatment effect. Effect was calculated per intervention type, and positive effects were found for stress symptoms with a pooled effect size of − 0.865 (95% CI: − 1.229, − 0.502) and for coping with a pooled effect size of − 3.493 (95% CI: − 6.711, − 0.275).

Conclusion

It is tentatively concluded that school programs targeting stress management or coping skills are effective in reducing stress symptoms and enhancing coping skills. Future research should use clear quality criteria and strive for less diversity in methodology and outcome assessment.     

Attentional bias and anxiety in individuals with coronary heart disease

This study examined whether in an emotional Stroop task, individuals with coronary heart disease (CHD) would show greater attention towards the threatening words related to their disease than healthy persons, and if such an attentional bias is associated with anxiety. An emotional Stroop task with threatening words related to CHD as well as positive, negative and neutral words was administered to 35 individuals with CHD and 35 healthy controls. Additionally, the original Stroop task, the Beck anxiety inventory and the state-trait anxiety inventory were administered. The results indicated an attentional bias towards threatening words related to CHD in the individuals with CHD. They experienced higher interference than healthy participants from threatening words related to CHD but not from positive or negative words. Moreover, the level of interference was associated with their level of anxiety, and a vicious circle may exist in this association. In addition, results indicated a possible deficit of executive functioning among individuals with CHD. Attentional bias, as well as its association with anxiety, and an indication of deficit in executive functioning among individuals with CHD might be the risk factors for these individuals’ quality of life and for further development of their disease.