Psychosocial adjustment and mental health two months after coronary artery bypass surgery: a multisystemic analysis of patients' resources

The Effect of Family Adaptation and Cohesion on the Well-being of Married Women: A Multiple Mediation Effect

In the years since the implementation of the two-child policy in China, there has been an increase in attention to the psychological status of married women. It is necessary to increase knowledge on the association between family cohesion and the adaptation of married women and their well-being. To accomplish this goal, the mediating variables of social support and positive coping style were examined in this paper. Married women were assessed using the Family Adaptation and Cohesion Scale, the General Well-Being Schedule, the Perceived Social Support Scale, and the Positive Coping Style Scale. The 353 participants were married women across three provinces in China. The results indicated that (1) there is a significant positive correlation between family cohesion, adaptation, subjective well-being, age, and employment status; (2) there is a correlation between perceived social support, family adaptation and cohesion, and well-being; and (3) the effect of family cohesion and adaptation on subjective well-being is mediated by perceived social support and positive coping style. Therefore, married women with good family adaptation and cohesion can get adequate support from family members and have higher subjective well-being.

Psychosocial Stress Reactivity as Predictor of Operative Outcome in Lumbar Disc Surgery

BACKGROUND

A large proportion of the population suffers from chronic back pain. For optimal treatment, the question arises which patients would benefit from conservative therapy and for whom lumbar disc surgery is most appropriate. It seems reasonable to analyze the impact of paraclinical parameters on the operation outcome to identify patients who would benefit less from surgery or need special pre-/postoperative medical care.

MATERIALS AND METHODS

From March 2012 to July 2014, 32 patients were treated via microscopically supported interlaminar fenestration and discectomy at the Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden. One day before the operation, a cortisol survey was made during the stress response of the Trier Social Stress Test. At the same time, a survey of relevant questionnaires was conducted by which the postoperative symptom experience was made operational and comparable with the evaluation of the same information thirty days afterwards.

RESULTS

It could be shown that there is a connection between cortisol reactivity and the pain burden following operations. Patients with a greater cortisol reaction under stress exposition partially experienced more intense postoperative pain than the patients with a lower cortisol reaction. However, this relationship could only be explained by single significant results, whereas further calculations could not produce any significance.

CONCLUSIONS

Cortisol reactivity seems to be associated with pain development. The inconsistent findings in empiricism as well as in this investigation are indicative of a complex association of postoperative pain and cortisol reactivity, which needs to be examined further.

Predictors of preoperative anxiety in surgical inpatients

AIMS AND OBJECTIVES

The aims of the present study were to identify the levels of preoperative anxiety in patients undergoing elective surgery and the relationship between preoperative anxiety and social support. In addition, predictors of preoperative anxiety were studied in surgical inpatients.

BACKGROUND

Major life changes are significant factors that cause anxiety; hospitalisation and surgery are among such changes. Social support may decrease the anxiety associated with surgery.

DESIGN

This is a descriptive study that included 500 patients in a surgery clinic.

METHODS

The data collected included: A Patient Information Form, Multidimensional Scale of Perceived Social Support and the Surgical Anxiety Scale. The results were analysed using the Chi-square test and logistic regression analysis. RESULTS; Five hundred patients participated in this research: 59·6% were female, 54·6% were 65 years of age or older, 80·6% were married, 70·4% were literate and 62% of the patients had moderate level surgery. There was a significant relationship between the sociodemographic patient features, the level of preoperative anxiety (p < 0·05), the presence of social support and the severity of anxiety (p = 0·001). The age and level of anxiety were not significant factors. The mean anxiety score for all patients was 31·91 (SD 6·30) and the mean social support score was 66·38 (SD 13·69).

CONCLUSION

The results of this study showed that the preoperative anxiety of patients awaiting surgery was associated with demographic characteristics as well as social support resources.

RELEVANCE TO CLINICAL PRACTICE

Anxiety testing is feasible during the preoperative period. Such testing allows for the detection of patients with high anxiety, and for clinicians to take the appropriate steps to ameliorate this problem. Identification of patient anxiety allows for providing a focus on social support in an attempt to reduce the level of anxiety.

Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues

OBJECTIVE

Cultural nuances may influence the interface between the cancer experience and marital issues, specifically for the partner. Most of the literature has focused on the woman's narrative or couple's adjustment to cancer in general. The purpose of this study was to describe and compare the marital relationship, sexuality, and marital adjustment of Israeli and Chinese husbands of women with breast cancer and the discussion of the health-care team concerning these issues.

METHODS

A convenience sample of 50 Chinese and 50 Israeli men, ages of 28-79 years, completed components of the Psychological Adjustment to Illness Scale, the Locke Wallace Adjustment Scale, and a background questionnaire.

RESULTS

The majority of husbands were in their first marriage. The average time since diagnosis was 16.7 months. No significant difference was found between the two groups on issues of marital relationship. Significant differences were found between Israeli and Chinese husbands on sexual interest, pleasure, and performance (p<0.05). Israeli husbands reported a significantly higher level of marital adjustment as opposed to the Chinese husbands (p = 0.006). Marital adjustment for both groups was significantly related only to perceived quality of the relationship (p<0.03).

CONCLUSIONS

Significant cultural differences were found in sexuality variables with no differences discerned on marital relationship variables. Couple-based interventions for marital issues are a critical component of support for both partners. Culturally sensitive assessment and care of the spouse as well as the woman with breast cancer should be part of a holistic, comprehensive family care plan.

Information, social support and anxiety before gastrointestinal endoscopy

OBJECTIVES

To examine Lazarus and Folkman's (1984) stress theory regarding the effects of the stress mediators information and perceived social support on anxiety (as the stress response) regarding gastrointestinal (GI) endoscopy (as the stressor) in male and female patients of various age groups.

DESIGN

Non-experimental design.

METHODS

Structured interviews were conducted with 113 hospital out-patients about to undergo GI endoscopy. Participants indicated their perceptions of how much support and how much clear and useful information they had received from both their general practitioner (GP) and a patient information leaflet developed in collaboration with health psychologists as well as their perceptions of how much social support they had obtained from other patients, family and friends. Anxiety was measured with a population-specific trait and state adaptation of the Hospital anxiety and depression scale (HADS-A).

RESULTS

Psychometric exploration of the HADS-A revealed a single general anxiety factor. The reliability of this factor was high, with Cronbach's alpha=0.91. The majority of the sample experienced high anxiety levels. Gender, but not age, differences emerged, showing females to be more anxious than males, F(1, 84)=5.68, p<.05. A regression model built on stress theory was tested, with anxiety as the dependent variable and 11 predictor variables. The model was significant with R(2)=0.452, F(11, 47)=3.522 and p=0.001.

CONCLUSIONS

The clarity, but not the amount, of information and social support from important others, but not GPs, were both mediating the stress experience of the patients by reducing their perceived anxiety.

The relationship between marital quality and coronary artery bypass graft surgery as experienced by 3 couples

PURPOSE

Marital quality is a key factor in the lived experiences of couples in which one of the partners has undergone coronary artery bypass graft (CABG) surgery. Previous research about marital quality has been largely quantitative, and few studies have explored more holistically the marital couple and their experience of a major medical procedure. The purpose of this study was to understand the relationship between marital quality and the ongoing dynamic of a couple's experience of bypass surgery.

METHODS

The study used the descriptive phenomenological-psychological method. The sample (N = 6) included 3 couples recruited from the Cardiac Wellness Institute of Calgary, Alberta, Canada, who were married, and one of the partners had undergone CABG surgery in the last 2 years. Two face-to-face interviews were conducted with each couple; the transcribed data were analyzed using the phenomenological method. All variables about the marital relationship that arose in the interviews were used as the data for analysis.

RESULTS

A single structure was developed that describes the marital couple and their lived experience of this major medical procedure. The invariant meanings of the structure highlighted areas such as the impact of long-standing relational patterns and levels of marital satisfaction on a couple's postoperative adjustment.

CONCLUSIONS

The findings of this study suggest that marital quality functioned as a major contributor (input) to couples' psychosocial recovery post-CABG surgery; conversely, bypass surgery highlighted existing levels of marital quality (output) and exacerbated weaknesses in the dyadic relationship.

Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight-loss program: the mediating role of emotional eating

OBJECTIVE

To examine a structural equation model of the effects of personal and interpersonal factors on treatment outcome of bariatric surgery and weight-loss program.

METHOD

Forty-four participants of the surgery group and 47 participants of the diet group completed questionnaires before treatment and 1 year afterward. Predictor measures are as follows: social support, motivation for control, sense of control, self-esteem, neuroticism, fear of intimacy, and emotional eating (EE).

OUTCOME MEASURES

Weight loss, quality of life, and mental health.

RESULTS

Neurotic predisposition (NP), a latent variable indicated by neuroticism, low self-esteem, and fear of intimacy, had an effect on weight loss that was fully mediated by EE. NP also had an effect on quality of life improvement that was fully mediated by EE and weight loss in both treatment groups.

DISCUSSION

Both NP and EE predict outcome of obesity treatments, but EE is the more proximal variable that mediates the effect of NP.

Factors associated with health-related quality of life in patients and significant others one month after coronary artery bypass grafting

AIM

To describe and compare the health-related quality of life of patients and their significant others and to identify factors associated with health-related quality of life one month after coronary artery bypass surgery.

BACKGROUND

Heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients might feel their quality of life is poor. Significant others are a major source of support for patients; therefore, it is important to know how their health-related quality of life is affected.

METHODS

This study is part of a major longitudinal research project. The questionnaire data for the study were collected one month after the surgical procedure from 270 patients and 240 significant others at one Finnish university hospital. Data analysis was by descriptive and inferential statistics. Stepwise linear regression analysis was used as a multivariate method.

RESULTS

Coronary artery bypass grafting patients had a poorer health-related quality of life than both the age and gender-standardised general population and their significant others. Significant others, on the other hand, had the same health-related quality of life as the general population. In patients, health-related quality of life was associated with the occurrence of cardiac symptoms and New York Heart Association class; in significant others, it was explained by chronic illnesses, employment, gender and emotional support received from members of the support network.

CONCLUSION

In the early stages of recovery, the health-related quality of life of coronary artery bypass grafting patients is inferior to that of the general population. There are also differences in the health-related quality of life of patients and their significant others.

RELEVANCE TO CLINICAL PRACTICE

Postcoronary artery bypass grafting rehabilitation programmes should provide support for both patients and significant others through networks that involve both professionals and peer supporters.

Physical, psychological and social recovery patterns after coronary artery bypass graft surgery: A prospective repeated measures questionnaire survey

AIM

This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months.

BACKGROUND

Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity.

DESIGN

A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies-Depression (CES-D).

RESULTS

Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery.

CONCLUSION

Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined.

RELEVANCE TO CLINICAL PRACTICE

Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients' recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients.

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.

Family support, living alone, and subjective health of a patient in connection with a coronary artery bypass surgery

OBJECTIVE

The study's objective was to evaluate the connections among family support, living alone, and subjective health after coronary artery bypass surgery (CABS).

DESIGN

This was a prospective and comparative follow-up study.

SETTING

The study took place in surgical clinics in two university hospitals in Finland.

PATIENTS

A total of 279 patients underwent CABS. The sample comprised consecutive patients who were willing to participate.

INTERVENTION

The patients were asked to evaluate their subjective health before surgery (initial phase) and 6 months after surgery (follow-up phase).

OUTCOME MEASURES

Outcome was measured by the Chest Pain and Dyspnea Scale, Modified Beck Depression Inventory, Endler Anxiety Scale, Family Support Scale, and Hopelessness items.

RESULTS

Subjective health improved significantly after CABS. Those who had lower family support before surgery had more depressive symptoms, anxiety, and hopelessness than those who had more support. In the group with low family support, the subjective health of women was poorer than that of men, and those who had no vocational education described poorer health than others. In the group with high family support, those who had no vocational education had more chest pain and dyspnea than others. Patients who were living alone had initially more depressive symptoms and hopelessness compared with patients living with someone. At follow-up, those living alone reported more chest pain and depressive symptoms than those living with someone. Patients aged less than 65 years and living alone reported more depressive symptoms, anxiety, and hopelessness than the oldest age group during the follow-up. In those patients living with someone, the subjective health of female patients, patients aged less than 65 years, and patients who had no vocational education was poorer than others.

CONCLUSIONS

High family support seemed to protect health and promote recovery. In nursing it is important to take care of those who receive only limited amount of family support or who live alone. These results suggest that women, patients aged less than 65 years, and patients with no vocational education may need additional support and care.

Social support and change in health-related quality of life 6 months after coronary artery bypass grafting

OBJECTIVE

We determined whether perceived social support predicted change in health-related quality of life, operationalized as change in mental health and physical functioning, 6 months after coronary artery bypass grafting (CABG).

METHODS

A prospective cohort of 1164 patients undergoing first CABG was interviewed prior to hospital discharge and 6 months later. Perceived instrumental and emotional support were assessed predischarge. Change in mental health and physical functioning was calculated as the difference between 6-month and predischarge SF-36 subscale scores. Stepwise linear regression analyses controlling for prior health-related quality of life, demographics, and clinical presentation were conducted.

RESULTS

A total of 1072 (1072/1164=92%) participants completed the 6-month interview; mean age 65.7 (+/-11.1) years. Frequent instrumental support predicted positive change in mental health (beta=3.27, P=.02); change scores were higher when participants had low pre-CABG mental health. Neither social support variable predicted change in physical functioning.

CONCLUSIONS

Assessing perceived instrumental support may help clinicians predict post-CABG mental health. More research regarding this relationship is needed before recommending intervention efforts.

Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation

This study examined the direct and mediated contributions of psychosocial variables to posttreatment physical functioning among 142 patients receiving cardiac rehabilitation. Two models were proposed and tested. In the first model, psychosocial factors were correlated and made to predict baseline and 6-week physical functioning. The results showed that after controlling for age, illness severity, baseline physical functioning, and other psychosocial correlates, optimism and social support still significantly predicted better posttreatment physical functioning. In the second model, we explored both the direct and mediational relationships between psychosocial factors and physical health outcomes. Optimism and social support were found to contribute to health outcomes not only directly but also indirectly through the mediation of less engagement in detrimental coping and lower depressive symptoms, whereas hostility and negative coping only predicted outcomes indirectly through mediators. These findings highlighted the importance of addressing psychosocial issues and their interrelationships in cardiac rehabilitation.

Predictors of pre- and postoperative anxiety in emergency surgery patients

OBJECTIVE

Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients.

METHODS

The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered.

DATA ANALYSIS

Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS).

RESULTS

There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety.

CONCLUSION

Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.

Family support and acceptance, gay male identity formation, and psychological adjustment: a path model

While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.