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Susinski S, Bouchard K, Stragapede E, Dozois S, Sterling E, Tulloch H. Psychological interventions targeting mental health and stress among females with cardiac disease: a scoping review. Can J Physiol Pharmacol 2024; 102:607-619. [PMID: 38587177 DOI: 10.1139/cjpp-2023-0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.
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Affiliation(s)
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Elisa Stragapede
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Sophie Dozois
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Evan Sterling
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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Issa R, Sfeir M, Azzi V, Salameh P, Akiki M, Akel M, Hallit S, Obeid S, Malaeb D, Hallit R. Association of Computer Vision Syndrome with Depression/Anxiety among Lebanese Young Adults: The Mediating Effect of Stress. Healthcare (Basel) 2023; 11:2674. [PMID: 37830711 PMCID: PMC10572235 DOI: 10.3390/healthcare11192674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
Computers have become indispensable in daily activities. With this excess use of electronics, computer vision syndrome (CVS), a highly prevalent condition, is associated with various symptoms. Although understanding the relationship between CVS and mental health has been reported, the impact of CVS has not been explored on more than one psychological aspect. We hypothesize that higher CVS symptoms could be associated with higher levels of anxiety and depression, mediated by higher stress. Therefore, the objective of this study was to determine the association between CVS and depression and anxiety among a sample of Lebanese young adults, along with evaluating the mediating effect of stress on these associations. Between August 2020 and April 2021, 749 participants completed an online questionnaire for this cross-sectional study. Females compared to males (Beta = 3.73) and those with CVS compared to those who did not (Beta = 3.14) were significantly associated with more anxiety, whereas having a university level of education compared to secondary or less (Beta = -3.02) was significantly associated with less anxiety. Females compared to males (Beta = 2.55) and those with CVS compared to those without (Beta = 2.61) were significantly associated with more depression, whereas being of an older age (Beta = -0.18) was significantly associated with less depression. Stress partially mediated the association between CVS and anxiety and between CVS and depression. More CVS was significantly associated with more stress (Beta = 3.05). Higher stress was significantly associated with more anxiety (Beta = 0.70) and depression (Beta = 0.71), whereas more CVS was significantly and directly associated with more anxiety (Beta = 3.14) and depression (Beta = 2.61). This study is the first worldwide to evaluate an association between CVS and mental health. Our results serve as a starting point for healthcare providers (psychiatrists and psychologists, most importantly) to look deeper into CVS when looking for reasons behind mental health issues. Further studies are warranted to confirm our results and look for more factors and mediators in such associations.
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Affiliation(s)
- Rita Issa
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon; (R.I.); (V.A.); (S.H.); (R.H.)
| | - Michel Sfeir
- Faculty of Social and Political Sciences (SSP), Institute of Psychology (IP), University of Lausanne, 1015 Lausanne, Switzerland;
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon; (R.I.); (V.A.); (S.H.); (R.H.)
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos 5053, Lebanon;
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon;
- Medical School, University of Nicosia, 2417 Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat 1103, Lebanon
| | - Maria Akiki
- Department of Internal Medicine, Saint Michael’s Medical Center, Newark, NJ 07102, USA;
| | - Marwan Akel
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon;
- School of Pharmacy, Lebanese International University, Beirut P.O. Box 146404, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon; (R.I.); (V.A.); (S.H.); (R.H.)
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib P.O. Box 60096, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil P.O. Box 13-5053, Lebanon;
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon; (R.I.); (V.A.); (S.H.); (R.H.)
- Department of Infectious Disease, Notre-Dame des Secours University Hospital, Byblos Postal Code 3, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh P.O. Box 295, Lebanon
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Helping Us Heal: telephone versus in-person marital communication and support counseling for spouse caregivers of wives with breast cancer. Support Care Cancer 2021; 30:793-803. [PMID: 34386885 PMCID: PMC8363089 DOI: 10.1007/s00520-021-06439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022]
Abstract
Purpose (1) To test the short-term impact of Helping Us Heal (HUSH), a telephone-delivered counseling program for spouse caregivers of women with breast cancer. (2) To compare outcomes from HUSH with outcomes from a historical control group which received the same program in-person. Methods Two-group quasi-experimental design using both within- and between-group analyses with 78 study participants, 26 in the within-group and 52 in the between-group analyses. Spouse caregivers were eligible if the wife was diagnosed within 8 months with stage 0–III breast cancer and were English-speaking. After obtaining signed informed consent and baseline data, 5 fully scripted telephone intervention sessions were delivered at 2-week intervals by patient educators. Spouses and diagnosed wives were assessed on standardized measures of adjustment at baseline and immediately after the final intervention session. Results Within-group analyses revealed that spouses and wives in HUSH significantly improved on depressed mood and anxiety; spouses improved on self-efficacy and their skills in supporting their wife. Additionally, wives’ appraisal of spousal support significantly improved. Between-group analyses revealed that outcomes from HUSH were comparable or larger in magnitude to outcomes achieved by the in-person delivered program. Conclusions A manualized telephone-delivered intervention given directly to spouse caregivers can potentially improve adjustment in both spouses and diagnosed wives but study outcomes must be interpreted with caution. Given the small samples in the pilot studies and the absence of randomization, further testing is needed with a more rigorous experimental design with a larger study sample.
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Liblik K, Mulvagh SL, Hindmarch CCT, Alavi N, Johri AM. Depression and anxiety following acute myocardial infarction in women. Trends Cardiovasc Med 2021; 32:341-347. [PMID: 34363978 DOI: 10.1016/j.tcm.2021.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is the leading global cause of mortality, with ischemic heart disease causing the majority of cardiovascular deaths. Despite this, diagnostic delay commonly occurs in women experiencing acute myocardial infarction (AMI) who have a higher associated in-hospital mortality. Several studies have demonstrated that women are significantly more likely than men to experience depression and anxiety following AMI which is linked with increased morbidity, rehospitalization, and mortality, as well as decreased quality of life. Thus, it is imperative that future work aims to understand the factors that put women at higher risk for depression and anxiety following AMI, informing prevention and intervention. This narrative review will summarize the current literature on the association between AMI and mental health in women, including the impact on morbidity, mortality, and quality of life.
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Affiliation(s)
- Kiera Liblik
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Charles C T Hindmarch
- Queen's Cardiopulmonary Unit, Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, Kingston, ON, Canada.
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O'Neil A, Russell JD, Murphy B. How Does Mental Health Impact Women's Heart Health? Heart Lung Circ 2020; 30:59-68. [PMID: 32665170 DOI: 10.1016/j.hlc.2020.05.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
From adolescence until old age, women are more vulnerable to common mental disorders (CMDs; depression and anxiety) than men at all stages of the life course. By middle age, women who have clinical depression are at twice the risk of having an incident cardiovascular disease (CVD) than those without. This has important implications for the way we prevent, identify and treat both CMDs and coronary heart disease in women. In this paper, we discuss the various genetic, biological, ethnic/racial, and psychological pathways by which women's vulnerability to CMDs elevate their CVD risk and recovery from a cardiac event. We review the evidence from trials that have, to date, failed to show that treating depression can reduce or delay the onset or recurrence of CVD events, especially for female patients. We discuss the value of lifestyle-based therapies for treating depression, to which women may be more responsive, and finish by discussing how population-based approaches including risk factor assessment could be tailored to consider these factors.
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Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Faculty of Health, Deakin University, Melbourne, Vic, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia
| | - Barbara Murphy
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Australian Centre for Heart Health, Melbourne, Vic, Australia; Department of Psychology, University of Melbourne, Melbourne, Vic, Australia
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Al-Dweik G, AbuRuz ME. Validation of the Arabic Version of the Brief Symptom Inventory to Measure Anxiety in Patients With Acute Myocardial Infarction. J Nurs Meas 2020; 28:JNM-D-18-00089. [PMID: 32179722 DOI: 10.1891/jnm-d-18-00089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Anxiety after acute myocardial infarction is well-known phenomenon. This study aimed to examine the psychometric properties of the Arabic version of the Brief Symptom Inventory to measure anxiety in this population. METHODS This was a prospective observational study among 460 patients. Patients answered the Brief Symptom Inventory and the Hospital Anxiety and Depression Scale to measure anxiety. Complications and other clinical variables abstracted from medical records. RESULTS Cronbach's α was .86, indicating adequate internal consistency. The item-total correlations and all interitem correlations were all acceptable. Anxiety was independent predictor for complication after acute myocardial infarction and higher in females supporting the construct validity. CONCLUSION Arabic version of the Brief Symptom Inventory is a valid and reliable instrument to measure anxiety after acute myocardial infarction.
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Alemán JF, Rueda B. [Influence of gender on protective and vulnerability factors, adherence and quality of life in patients with cardiovascular disease]. Aten Primaria 2019; 51:529-535. [PMID: 30348466 PMCID: PMC6945135 DOI: 10.1016/j.aprim.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/26/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine gender differences on specific protective factors (PF: acceptance and resilience), vulnerability factors (VF: anger, depression, and anxiety; adherence to treatment and quality of life (QoL) in cardiovascular patients, as well as to study separately the relationships of these factors with adherence and QoL in females and males. DESIGN Observational and cross-sectional. SETTING Two Primary Care Centres in Gran Canaria. PARTICIPANTS One hundred and ninety-eight cardiovascular patients (91 males and 107 females) participated. MAIN MEASUREMENTS Acceptance was assessed by the ICQ scale; resilience by the CD-RISC; depression by the PHQ-9; anxiety by the HADS; Anger-In and Anger-Out by the STAXI-2; QoL by the SF-36; and adherence by a self-reported scale. RESULTS Females exhibited higher anxiety (95% CI: 6.3-7.9) and adherence to reducing smoking (95% CI: 9.4-10.0) and drinking (95% CI: 9.6-10.1), and lower Anger-Out (95% CI: 8.9-10.0), mental QoL (95% CI: 47.0-51.3) and adherence to medication (95% CI: 22.2-23.3) compared to males. Acceptance was associated with better adherence only in women. There were more VF related to worse adherence in males. Anxiety had a negative impact on adherence, and QoL was positively associated with PF, and negatively with VF in both groups. CONCLUSIONS Gender differences in QoL, some VF, and adherence are observed, in addition to the beneficial role of Acceptance in women.
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Affiliation(s)
- Juan Francisco Alemán
- Departamento de Psicología de la Personalidad, Evaluación y Tratamiento Psicológicos, Universidad Nacional de Educación a Distancia, Madrid, España; Centro de Salud de Agaete, Agaete, Gran Canaria, Las Palmas, España.
| | - Beatriz Rueda
- Departamento de Psicología de la Personalidad, Evaluación y Tratamiento Psicológicos, Universidad Nacional de Educación a Distancia, Madrid, España
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Abstract
Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.
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Nasiłowska-Barud A, Zapolski T, Barud M, Wysokiński A. Overt and Covert Anxiety as a Toxic Factor in Ischemic Heart Disease in Women: The Link Between Psychological Factors and Heart Disease. Med Sci Monit 2017; 23:751-758. [PMID: 28187122 PMCID: PMC5317281 DOI: 10.12659/msm.902544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Long-term clinical observations have shown that anxiety disorders influence the etiopathogenesis of ischemic heart disease (IHD) in women. The aim of this study was to determine the characteristics of the structure of overt and covert anxiety, and to examine the impact of the severity of anxiety on five personality traits as described Costa and McCrae. Material/Methods The study involved 50 women aged 37 to 74 years, who were treated because of IHD that was confirmed by angiographic examination of the coronary vessels. Psychological studies were conducted using the IPAT Anxiety Scale (Cattell) and NEO-FFI Personality Inventory (Costa and McCrae). Results From among the 50 women with IHD included in the study, 28 had higher overt anxiety scores than covert anxiety scores. Women with high overt anxiety were more emotionally changeable (C−), became impatient more easily, and expressed disappointment with life. They also worried about life problems more frequently. They had considerable suspiciousness (L+) and less trust towards the environment. They had a much stronger tendency to blame themselves (O+) and had intense internal, neurotic tension (Q4+). Women with high levels of overt anxiety had more neurotic traits (NEU), and lower openness to experience (OPE) scores. Conclusions Women with IHD were characterized by a high level of unease and anxiety. This may have resulted from lack of personality harmony, lack of personality integrity, or experienced value crises. Internal tension, auto-aggression, lowered emotional stability, and a sense of threat dominate the structure of unease and anxiety.
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Affiliation(s)
- Alicja Nasiłowska-Barud
- Department of Clinical Psychology, Medical University of Lublin, Lublin, Poland.,Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Małgorzata Barud
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
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Steinke EE, Wright DW. The Role of Sexual Satisfaction, Age, and Cardiac Risk Factors in the Reduction of Post-MI Anxiety. Eur J Cardiovasc Nurs 2016; 5:190-6. [PMID: 16442845 DOI: 10.1016/j.ejcnurse.2005.12.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2005] [Revised: 12/08/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anxiety is common after myocardial infarction (MI); however, little is known about the role of sexual satisfaction and return to sexual activity on anxiety post-MI. AIM To examine the role of sexual satisfaction in reducing anxiety post-MI. METHODS Patients with acute myocardial infarction (MI) recruited from one U.S. medical center completed questionnaires at baseline while hospitalized and at 1, 3, and 5 months post-MI. This analysis includes 64 patients compared on low or high anxiety at 5 months post-MI using sexual satisfaction and selected demographic and clinical variables in the analysis. RESULTS Patients with high anxiety scores reported lower sexual satisfaction (p < .001) and a higher percentage of coronary risk factors (p < .01). The OLS regression model provided similar results with an adjusted R-square of .422, accounting for approximately 42% of anxiety (p < .001). Sexual satisfaction accounted for the most variance in the model, showing an inverse relationship between sexual satisfaction and anxiety. An inverse relationship also existed between age and anxiety. CONCLUSIONS Anxiety is common after MI, and decreased sexual satisfaction appears to contribute to heightened anxiety. Attention to sexual concerns of MI patients before and after hospital discharge may improve psychosocial outcomes.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, Kansas, 67260-0041, USA.
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De Jong MJ, Chung ML, Roser LP, Jensen LA, Kelso LA, Dracup K, McKinley S, Yamasaki K, Kim CJ, Riegel B, Ball C, Doering LV, An K, Barnett M, Moser DK. A Five-Country Comparison of Anxiety Early after Acute Myocardial Infarction. Eur J Cardiovasc Nurs 2016; 3:129-34. [PMID: 15234317 DOI: 10.1016/j.ejcnurse.2004.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Revised: 12/19/2003] [Accepted: 01/15/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety is common after acute myocardial infarction (AMI) and has the potential to negatively affect physical and psychosocial recovery. There have been no cross-cultural comparisons of anxiety among AMI patients. AIMS To evaluate whether anxiety after AMI differs across five diverse countries and to determine whether an interaction between country, and sociodemographic and clinical variables contributes to variations in reporting anxiety. METHODS AND RESULTS A total of 912 individuals with confirmed AMI were enrolled in this prospective, comparative, cross-cultural study. Anxiety was assessed within 72 h of hospital admission using the Brief Symptom Inventory. The mean level of anxiety in the entire sample was 0.62+/-0.76, which is 44% higher than the normal mean level. Anxiety levels were not significantly different among the countries with the exception that patients in England reported lower levels of anxiety than those in the US (P=0.03). However, this difference disappeared after controlling for sociodemographic variables on which the countries differed. CONCLUSION Patients from each country studied experienced high anxiety after AMI. Even though various cultures were represented in this study, culture itself did not account for variations in anxiety after AMI. It appears that anxiety after AMI is a universal phenomenon.
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Affiliation(s)
- Marla J De Jong
- University of Kentucky, College of Nursing /US Air Force, Lexington, KY, USA
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Yuval R, Halon DA, Lewis BS. Perceived Disability and Lifestyle Modification Following Hospitalization for Non-ST Elevation Versus ST Elevation Acute Coronary Syndromes: The Patients' Point of View. Eur J Cardiovasc Nurs 2016; 6:287-92. [PMID: 17449324 DOI: 10.1016/j.ejcnurse.2007.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Revised: 02/06/2007] [Accepted: 02/16/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Medical personnel generally believe that non-ST elevation (NSTE) acute coronary syndromes (ACS) are less damaging than ST elevation myocardial infarction (STEMI), in keeping with the lower morbidity and mortality attributed to these subgroups in randomized clinical trials. We examined whether this concept translates into a difference from the patients' point of view regarding lifestyle modification and return to work following hospitalization for ACS. METHODS A structured anonymous self-completed questionnaire was mailed and returned by 160 consecutive patients (age 64+/-11 years; 125 (78%) men) 3-12 months after hospitalization for ACS. In 49 patients, the diagnosis was unstable angina pectoris (UAP), in 34 non-ST elevation myocardial infarction (NSTEMI) and in 73, ST elevation myocardial infarction (STEMI). The questionnaire addressed issues relating to demographic data, medical history, occupation, employment and income before the acute event, changes following hospitalization for ACS and questions relating to current perceived health status and return to work. RESULTS Most (98/159, 62%) patients saw themselves as "heart patients" after hospitalization for ACS. Quality of life was perceived to have decreased in 70 (44%), self-image in 85 (53%), self-confidence in 78 (49%) and sexual function in 75 (48%), with no differences according to ACS type. Anxiety was reported by 85 (54%) patients and anxiety level (1.47+/-1.25 on the Brief Symptom Inventory scale) was high. Only 38 (49%) of 77 patients who were working prior to the acute event returned to full- or part-time gainful employment. By multivariate analysis, return to work was associated with 3 variables: younger age (p=0.015), shorter duration of hospitalization (p=0.036) and higher income bracket prior to the acute event (p=0.0001), with no relation to gender, in-hospitalization revascularization strategy, rehabilitation program or to underlying cardiac diagnosis (UAP, NSTEMI or STEMI). CONCLUSIONS Hospitalization for ACS had a major negative impact on patient lifestyle and return to work, irrespective of the underlying cardiac diagnosis. The experience of hospitalization for an acute heart condition was uniformly traumatic with in many instances a prolonged adverse effect on patient function.
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Affiliation(s)
- Rita Yuval
- Cardiovascular Clinical Research Unit, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
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Gender differences in outpatients with anxiety disorders: the Leiden Routine Outcome Monitoring Study. Epidemiol Psychiatr Sci 2016; 25:278-87. [PMID: 25989916 PMCID: PMC6998770 DOI: 10.1017/s2045796015000414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Data from the general population show higher prevalence of different anxiety disorders in women as compared with men. We analysed gender differences in a naturalistic sample of outpatients with anxiety disorders in a mental healthcare setting. METHOD Routine outcome monitoring data were collected from 1333 patients (age: 18-65; 63.3% women) fulfilling Diagnostic and Statistical Manual of Mental Disorders IV criteria of current anxiety disorder according to the Mini-International Neuropsychiatric Interview between 2004 through 2006. Data included Comprehensive Psychopathological Rating Scale, Brief Symptom Inventory (BSI), Short Form Health Survey (SF-36), Mood and Anxiety Symptom Questionnaire (MASQ). Chi-squared test and t-test were used to compare women with men for variables with parametric distributions, and Mann-Whitney test for non-parametric distribution. Adjustments for potential confounders (age, level of education, ethnicity and comorbidites) were made by logistic regression models (for discrete variables) or analysis of covariance. RESULTS The female-to-male ratio (i.e., 844 women, 489 men) for any anxiety disorder was 1.73 : 1 (95% confidence interval [CI]: 1.63-1.83), with the strongest skewness for post-traumatic stress disorder (2.80 : 1) and the smallest one for social phobia (1.18 : 1). Compared with men, women reported more severe self-rating scores on the BSI (on average, the scores were 12.3% higher on 3 of 9 subscales: somatisation, interpersonal sensitivity and anxiety), SF-36 (self-reported generic health status was lower on 5 of 8 subscales: physical functioning, social functioning, physical problems, vitality and bodily pain) and MASQ (on average, the scores were 6.6% higher on 4 of 5 subscales: anxious arousal, general distress, general distress depression, general distress anxiety). On the contrary, no gender difference was found in the severity of anxiety symptoms measured by the Brief Anxiety Scale. Women were more likely to suffer from comorbid depression and bulimia nervosa, and less likely from substance abuse. CONCLUSIONS In a treatment-seeking population the prevalence rate of anxiety disorders was 1.7 times higher in female compared with men. Female outpatients were more severely affected on self-rated but not on observer-rated scales.
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Perpiñá-Galvañ J, Cabañero-Martínez MJ, Richart-Martínez M. Reliability and validity of shortened state trait anxiety inventory in Spanish patients receiving mechanical ventilation. Am J Crit Care 2013; 22:46-52. [PMID: 23283088 DOI: 10.4037/ajcc2013282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND In order to measure anxiety in physically and cognitively debilitated patients, such as patients receiving invasive mechanical ventilation, the use of reliable and valid instruments is recommended; however, these instruments should be short. OBJECTIVE To analyze the reliability and validity of a short version of the state subscale from the Spielberger State-Trait Anxiety Inventory, developed by Chlan and colleagues and translated into Spanish (STAI-E6), in patients receiving invasive mechanical ventilation. METHODS An instrumental study was conducted of 80 patients receiving invasive mechanical ventilation in the intensive care unit at the Hospital of Alicante (Spain). The patients completed the 6-item STAI-E6 scale. Before the patients completed the scale, the interviewers indicated their impression of each patient's level of anxiety by using a linear scale. Internal consistency, construct validity, and convergent validity of the scale were analyzed. RESULTS The scale did not present a floor/ceiling effect, the Cronbach α was 0.79, and the single-factor structure of the original scale was maintained. Scores on the scale correlated positively with the subjective assessment of the health professional. Significant differences were found only between anxiety level and duration of intubation. CONCLUSIONS The 6-item version of the state subscale from the STAI-E6 shows satisfactory reliability and validity for Spanish patients receiving invasive mechanical ventilation.
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Affiliation(s)
- Juana Perpiñá-Galvañ
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - María José Cabañero-Martínez
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - Miguel Richart-Martínez
- Juana Perpiñá-Galvañ and María José Cabañero-Martínez are registered nurses with doctoral degrees in nursing, and Miguel Richart-Martínez is a doctorally prepared psychologist. All are associate professors in the Nursing Department, Universidad de Alicante, Alicante, Spain
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Coping Experiences: A Pathway towards Different Coping Orientations Four and Twelve Months after Myocardial Infarction-A Grounded Theory Approach. Nurs Res Pract 2012; 2012:674783. [PMID: 23304483 PMCID: PMC3523568 DOI: 10.1155/2012/674783] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 09/21/2012] [Accepted: 10/19/2012] [Indexed: 12/05/2022] Open
Abstract
Background. Patients recovering from a myocardial infarction (MI) are faced with a number of serious challenges. Aim. To create a substantive theory on myocardial infarction patients' coping as a continuum. Methods. Grounded theory method was used. Data were collected by using individual interviews. The informants were 28 MI patients. Results. The core category “coping experiences—a pathway towards different coping orientations” includes 2 main categories: “positive and negative coping experiences” (4 months after MI) and “different coping orientations” (12 months after MI). Conclusion. Coping with a myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. Coping is threatened, if the patient denies the seriousness of the situation, suffers from depression and emotional exhaustion, or if there are serious problems in the interaction with family members. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centered approach involving a posthospital counseling intervention is recommended. Relevance to Clinical Practice. The results of this study can be used in nursing care practice when organizing support interventions for myocardial infarction patients.
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Boyer BA, Matour SJ, Crittenden KB, Larson KA, Cox JM, Link DD. Appraisals of Fear, Helplessness, and Perceived Life-Threat During Emergent Cardiac Surgery: Relationship to Pre-surgical Depression, Trauma History, and Posttraumatic Stress. J Clin Psychol Med Settings 2012. [DOI: 10.1007/s10880-012-9330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Luo YY. Effects of written plus oral information vs. oral information alone on precolonoscopy anxiety. J Clin Nurs 2012; 22:817-27. [PMID: 22845184 DOI: 10.1111/j.1365-2702.2011.04053.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To determine the effect of written plus oral information vs. oral information alone on precolonoscopy anxiety. BACKGROUND Information provision has been considered to reduce precolonoscopy anxiety. However, the best means to provide information before colonoscopy has not yet been determined as there is inconsistency in the outcomes of the clinical trials. DESIGN A two-group, pretest, post-test, prospective, quasi-experimental design with non-random assignment. METHODS Participants were assigned to group 1 or 2 in the study. In the enrolment all the participants completed the questionnaires to collect personal characteristics data and assessed subjects' anxiety level by the Chinese version of the State Scale of State-Trait Anxiety Inventory as baseline data. After that, subjects in group 1 received written plus oral information before colonoscopy, while those in group 2 received oral information before colonoscopy. On the day for colonoscopy all subjects completed the Chinese version of the State Scale of State-Trait Anxiety Inventory again. RESULTS There was no difference in state anxiety and personal characteristic between the two groups at enrolment. After the intervention, although the state anxiety scores were dropped, there were no statistical significant differences between two groups or within groups 1 and 2. CONCLUSIONS Information provision before colonoscopy did not reduce the anxiety level in patients directly before colonoscopy. RELEVANCE TO CLINICAL PRACTICE There was a trend that information had a positive effect on patients' state anxiety. Future information provision studies may need to add more interactive methods appropriately and take patients' gender, educational level and coping style into consideration.
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Affiliation(s)
- Yuan-Yuan Luo
- School of Medicine, Jianghan University, Wuhan, Hubei, China.
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The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease. Eur J Cardiovasc Nurs 2012; 11:160-7. [PMID: 21126918 DOI: 10.1016/j.ejcnurse.2010.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that interventions not increase anxiety. PURPOSE To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms. METHODS This was a multicenter randomized controlled trial of the intervention in which anxiety data were collected at baseline, 3-months and 12-months. A total of 3522 patients with confirmed coronary artery disease were enrolled; data from 2597 patients with anxiety data at all time points are included. The intervention was a 45 min education and counseling session, in which the social, cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking. Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age, gender, ethnicity, education level, and comorbidities. RESULTS There were significant differences in anxiety by group (p = 0.03). Anxiety level was stable in patients in the control group, but decreased across time in the intervention group. Perceived control increased across time in the intervention group and remained unchanged in the control group (p = 0.01). CONCLUSION Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.
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McKinley S, Fien M, Riegel B, Meischke H, Aburuz ME, Lennie TA, Moser DK. Complications after acute coronary syndrome are reduced by perceived control of cardiac illness. J Adv Nurs 2012; 68:2320-30. [PMID: 22235775 DOI: 10.1111/j.1365-2648.2011.05933.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the relationship between anxiety, perceived control and rate of in-hospital complications after acute coronary syndrome. BACKGROUND Anxiety may be associated with higher risk of complications following acute myocardial infarction; perceived control may moderate this relationship. DESIGN Prospective observational study. METHODS Patients enrolled in a trial investigating delay in seeking treatment for acute coronary syndrome had anxiety measured at enrolment and 3 months using the Brief Symptom Inventory anxiety subscale. The acute coronary syndrome hospital presentations investigated occurred between 2001-2006. Patients with anxiety scores greater than the population norm at both time points were categorized as persistently anxious. Perceived control was measured at enrolment using the control attitudes scale-revised. Data were collected from the medical record on in-hospital complications in patients presenting with acute coronary syndrome within 2 years of enrolment. Chi-square and t-tests were used for univariate analyses and multiple logistic regression to identify independent predictors of complications. RESULTS Patients (n = 171) were 64% men with mean age 69 years. Ischaemic or arrhythmic complications occurred in 26 patients (15%) with no difference in complication rates between those persistently anxious and others. Important univariate predictors of in-hospital complications were lower perceived control, diagnosis of acute myocardial infarction, heart failure and higher pulse rate on admission. Low perceived control and diagnosis of acute myocardial infarction were independent predictors of in-hospital complications in the multiple logistic regression. CONCLUSION Perceived control, but not persistent anxiety, prior to acute coronary syndrome was an important predictor of in-hospital complications after acute coronary syndrome. Interventions to increase cardiac patients' perceived control of their cardiac illness may reduce in-hospital complications after acute coronary syndrome.
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Affiliation(s)
- Sharon McKinley
- Critical Care Nursing Professorial Unit, University of Technology, Sydney, Australia.
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Perpiñá-Galvañ J, Richart-Martínez M, Cabañero-Martínez MJ, Martínez-Durá I. Content validity of the short version of the subscale of the State-Trait Anxiety Inventory (STAI). Rev Lat Am Enfermagem 2012; 19:882-7. [PMID: 21876939 DOI: 10.1590/s0104-11692011000400005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 03/04/2011] [Indexed: 01/21/2023] Open
Abstract
The goal was to describe the content validity of a short version of the state subscale of Spielberger's "State-Trait Anxiety Inventory (STAI)", based on the original version adapted to Spanish, in Spanish patients receiving invasive mechanical ventilation (IMV). The sample consisted of 16 patients receiving IMV at the Alicante Hospital (Spain), who selected the items from the full Spanish version of the STAI-state that were most relevant to them. Items 1, 5, 9, 10, 12 and 20 from the original scale are the most relevant for the Spanish patients receiving IMV and 5 of these are included in the short version of the scale (83.3% agreement). The short scale has shown adequate content validity for Spanish patients receiving IMV.
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Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosom Med 2011; 73:803-9. [PMID: 22021458 DOI: 10.1097/psy.0b013e3182364992] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized. METHODS Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared. RESULTS Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]). CONCLUSIONS By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.
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Jeitziner MM, Hantikainen V, Conca A, Hamers JPH. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study. BMC Geriatr 2011; 11:52. [PMID: 21888641 PMCID: PMC3178472 DOI: 10.1186/1471-2318-11-52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 09/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1) to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2) to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use), living situation, and survival after discharge and at 6 and 12 months of follow-up. METHODS/DESIGN A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group). Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. DISCUSSION Little research has focused on long term consequences after ICU admission in older critically ill patients. The present study is specifically focussing on long term consequences of stress factors experienced during ICU admission. TRIAL REGISTRATION ISRCTN52754370.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital/Bern University Hospital and University of Bern, Bern, Switzerland.
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De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
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Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
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Impact of prehospital delay in treatment seeking on in-hospital complications after acute myocardial infarction. J Cardiovasc Nurs 2011; 26:184-93. [PMID: 21116191 DOI: 10.1097/jcn.0b013e3181efea66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown. OBJECTIVE The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling. METHODS Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record. RESULTS Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001). CONCLUSION Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.
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Moser DK, Dracup K, Evangelista LS, Zambroski CH, Lennie TA, Chung ML, Doering LV, Westlake C, Heo S. Comparison of prevalence of symptoms of depression, anxiety, and hostility in elderly patients with heart failure, myocardial infarction, and a coronary artery bypass graft. Heart Lung 2011; 39:378-85. [PMID: 20561849 DOI: 10.1016/j.hrtlng.2009.10.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/22/2009] [Accepted: 10/30/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study sought to compare the prevalence of anxiety, depression, and hostility among 3 clinically diverse elderly cardiac patient cohorts and a reference group of healthy elders. METHODS This was a multicenter, comparative study. A total of 1167 individuals participated: 260 healthy elders, and 907 elderly cardiac patients who were at least 3 months past a hospitalization (478 heart-failure patients, 298 postmyocardial infarction patients, and 131 postcoronary artery bypass graft patients). Symptoms of anxiety, depression, and hostility were measured using the Multiple Affect Adjective Checklist. RESULTS The prevalence of anxiety, depression, and hostility was higher in patients in each of the cardiac patient groups than in the group of healthy elders. Almost three quarters of patients with heart failure reported experiencing symptoms of depression, and the heart-failure group manifested the greatest percentage of patients with depressive symptoms. CONCLUSIONS The high levels of emotional distress common in cardiac patients are not a function of aging, because healthy elders exhibit low levels of anxiety, depression, and hostility.
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Affiliation(s)
- Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky 40536-0232, USA.
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Brouwers C, van den Broek KC, Denollet J, Pedersen SS. Gender disparities in psychological distress and quality of life among patients with an implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:798-803. [PMID: 21438898 DOI: 10.1111/j.1540-8159.2011.03084.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A subset of patients with an implantable cardioverter defibrillator (ICD) reports psychological distress and poor quality of life (QoL). Gender is one of the factors that has been proposed to explain individual differences in these outcomes. In this viewpoint, we (1) review the evidence for gender disparities in psychological distress and QoL in ICD patients by means of a systematic review, and (2) provide recommendations for future research and clinical implications. A systematic search of the literature identified 18 studies with a sample size ≥ 100 that examined gender disparities in anxiety/depression and QoL in ICD patients (mean prevalence of women = 21%; mean age = 62 years). Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients. Women had a higher prevalence of anxiety and poorer QoL in some studies, but there was no statistically significant gender effect in relation to 80% (26/32) of the outcomes reported in the 18 studies. Studies are warranted that are designed a priori and sufficiently powered to examine gender disparities in distress and QoL outcomes in order to establish the exact gender-specific effect. Due to a need to explore the complexity of this issue further, at this time, caution is warranted with respect to the clinical implications.
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Affiliation(s)
- Corline Brouwers
- Department of Medical Psychology and Neuropsychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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Abu Ruz ME, Lennie TA, Moser DK. Effects of β-blockers and anxiety on complication rates after acute myocardial infarction. Am J Crit Care 2011; 20:67-73; quiz 74. [PMID: 20107234 DOI: 10.4037/ajcc2010216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Anxiety is common after acute myocardial infarction and increases the number of complications and the length of stay in the hospital. Anxiety-induced activation of the sympathetic nervous system is hypothesized to be an underlying cause of increased complication rates. Little is known about whether use of β-blockers eliminates the effects of anxiety on complication rate and length of stay. OBJECTIVE To compare number of complications and length of stay among nonanxious and anxious patients receiving β-blockers during hospitalization. METHOD A total of 322 patients with acute myocardial infarction participated in this study within 48 hours of hospital admission. Patients completed the Brief Symptom Inventory to assess anxiety level. After discharge, medical records were reviewed to determine use of β-blockers, type and number of complications, and length of stay. RESULTS Most patients (96%) were treated with less than 200 mg daily of metoprolol. Anxious patients had more complications (mean [SD], 1.43 [0.15] vs 0.73 [.09], P ≤ .01) and longer stays (7.0 [0.49] vs 5.7 [0.36] days, P < .05) than did nonanxious patients. To test whether the dose of β-blocker made a difference, the interaction between daily dose and anxiety score was tested. No interaction was found between metoprolol dose and anxiety score, and no main effect was found for metoprolol dose. CONCLUSION Anxious patients had more complications and longer stays than did nonanxious patients. The administration of metoprolol did not eliminate this relationship, perhaps because patients did not receive a sufficient dose of metoprolol to counter the effect of anxiety.
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Affiliation(s)
- Mohannad E. Abu Ruz
- Mohannad E. Abu Ruz is an associate professor in the College of Medicine at Sultan Qaboos University in Muscat, Oman. Terry A. Lennie is an associate professor and Debra K. Moser is a professor and Gill Chair of Nursing in the College of Nursing at the University of Kentucky in Lexington
| | - Terry A. Lennie
- Mohannad E. Abu Ruz is an associate professor in the College of Medicine at Sultan Qaboos University in Muscat, Oman. Terry A. Lennie is an associate professor and Debra K. Moser is a professor and Gill Chair of Nursing in the College of Nursing at the University of Kentucky in Lexington
| | - Debra K. Moser
- Mohannad E. Abu Ruz is an associate professor in the College of Medicine at Sultan Qaboos University in Muscat, Oman. Terry A. Lennie is an associate professor and Debra K. Moser is a professor and Gill Chair of Nursing in the College of Nursing at the University of Kentucky in Lexington
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VAZQUEZ LAUREND, CONTI JAMIEB, SEARS SAMUELF. Female-Specific Education, Management, and Lifestyle Enhancement for Implantable Cardioverter Defibrillator Patients: The FEMALE-ICD Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1131-40. [DOI: 10.1111/j.1540-8159.2010.02787.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Evidence That the Brief Symptom Inventory Can Be Used to Measure Anxiety Quickly and Reliably in Patients Hospitalized for Acute Myocardial Infarction. J Cardiovasc Nurs 2010; 25:117-23. [DOI: 10.1097/jcn.0b013e3181b56626] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perpiñá-Galvañ J, Richart-Martínez M. Scales for evaluating self-perceived anxiety levels in patients admitted to intensive care units: a review. Am J Crit Care 2009; 18:571-80. [PMID: 19880959 DOI: 10.4037/ajcc2009682] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. METHODS The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación mecánica for the Spanish-language databases. Information was extracted from 18 selected articles on the level of anxiety experienced by patients and the psychometric properties of the instruments used to measure anxiety. RESULTS Moderate levels of anxiety were reported. Levels were higher in women than in men, and higher in patients undergoing positive pressure ventilation regardless of sex. Most multi-item instruments had high coefficients of internal consistency. The reliability of instruments with only a single item was not demonstrated, even though the instruments had moderate-to-high correlations with other measurements. CONCLUSION Midlength scales, such the anxiety subscale of the Brief Symptom Inventory or the shortened state version of the State-Trait Anxiety Inventory are best for measuring anxiety in critical care patients.
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Affiliation(s)
- Juana Perpiñá-Galvañ
- Juana Perpiñá-Galvañ is a registered nurse with a master of science degree in nursing and Miguel Richart-Martínez is a doctor in psychology in the Nursing Department, Universidad de Alicante, Alicante, Spain
| | - Miguel Richart-Martínez
- Juana Perpiñá-Galvañ is a registered nurse with a master of science degree in nursing and Miguel Richart-Martínez is a doctor in psychology in the Nursing Department, Universidad de Alicante, Alicante, Spain
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Chung ML, Moser DK, Lennie TA, Rayens MK. The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: testing dyadic dynamics using Actor-Partner Interdependence Model. J Psychosom Res 2009; 67:29-35. [PMID: 19539816 PMCID: PMC2732117 DOI: 10.1016/j.jpsychores.2009.01.009] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient-spouse dyads using an innovative dyadic analysis technique, the Actor-Partner Interdependence Model (APIM). METHOD A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% +/-11, 43% in New York Heart Association III-IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL. RESULT Depressive symptoms exhibited actor effect of both patients (P<.001) and spouses (P<.001) and only partner effect of patients (P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms. CONCLUSION Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses.
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Affiliation(s)
- Misook L. Chung
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Debra K. Moser
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Terry A. Lennie
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, Lexington, Kentucky
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Kuhl EA, Fauerbach JA, Bush DE, Ziegelstein RC. Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. Am J Cardiol 2009; 103:1629-34. [PMID: 19539067 DOI: 10.1016/j.amjcard.2009.02.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/10/2009] [Accepted: 02/10/2009] [Indexed: 11/25/2022]
Abstract
Unlike depression, the relation between anxiety and the adherence to risk-reducing recommendations after myocardial infarction (MI) has not been well studied. The aim of this study was to explore the effect of anxiety on adherence after MI. Patients (n = 278) hospitalized for MI were assessed for anxiety using the Beck Anxiety Inventory during the hospitalization (baseline) and at 4 months of follow-up. The measures of adherence included following a low-sodium, low-fat diet, exercising regularly, taking medications, decreasing stress, carrying medical supplies, increasing socialization, following a diabetic diet, measuring blood glucose levels, and smoking cessation (where applicable). Baseline anxiety was associated with younger age, female gender, hypertension, tobacco use, depression, and current mood disorder. At 4 months of follow-up, anxiety was also associated with living alone, a history of coronary artery disease, and Killip class >1. An anxiety summary score was calculated to assess anxiety across both points. Summary anxiety was associated with worse adherence to exercise, reducing stress, increasing socialization, and smoking cessation but with better adherence to carrying supplies (all p <0.05). After controlling for demographic, cardiovascular, and psychological factors, summary anxiety predicted worse adherence to reducing stress (p = 0.004) and increasing socialization (p = 0.033) and was the only significant predictor of worse adherence to smoking cessation (p = 0.001) and better adherence to carrying supplies (p = 0.04). Anxiety during the initial hospitalization and 4 months later was associated with lower adherence to many important risk-reducing recommendations after MI. In conclusion, additional research is needed to evaluate whether treating anxiety can improve adherence in this setting.
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Ylinen ER, Vehviläinen-Julkunen K, Pietilä AM. Effects of patients' anxiety, previous pain experience and non-drug interventions on the pain experience during colonoscopy. J Clin Nurs 2009; 18:1937-44. [PMID: 19374693 DOI: 10.1111/j.1365-2702.2008.02704.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper is a report of a study evaluating anxiety in patients prior to colonoscopy and identifying correlations between that anxiety, previous pain experience, non-drug interventions and pain intensity during colonoscopy. BACKGROUND Waiting for forthcoming procedures, such as colonoscopy, is stressful. However, a few studies have evaluated the influence of patients' anxiety, previous pain experience and non-drug interventions during colonoscopy. DESIGN A quantitative cross-sectional survey design was used. The data were collected from colonoscopy patients by using the Spielberger State Trait Anxiety Inventory and a questionnaire developed for the study. METHODS We assigned one hundred and thirty patients scheduled for diagnostic colonoscopy in a Finnish university hospital during 2006. Patients completed the State Trait Anxiety Inventory before and a questionnaire developed for the study after colonoscopy. RESULTS Most of the patients suffered from pain but they considered it to be tolerable. Women were more anxious before colonoscopy and experienced more pain and discomfort than men. Previous pain experiences and high state anxiety level decreased patients' perceptions of colonoscopy. Non-drug interventions, such as peaceful talk, explanation of the reason for pain and guidance helped both anxious and non-anxious patients to ease the pain. CONCLUSION Awareness and understanding of previous pain experiences and anxiety levels in patients are essential and must be taken into account. RELEVANCE TO CLINICAL PRACTICE Colonoscopy patients' clinical education should be developed so as to be more individual. Furthermore, nurses should be better aware of the positive effects of non-drug interventions and should use them as an element of pain management for colonoscopy patients.
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Pothoulaki M, Macdonald RAR, Flowers P, Stamataki E, Filiopoulos V, Stamatiadis D, Stathakis CP. An investigation of the effects of music on anxiety and pain perception in patients undergoing haemodialysis treatment. J Health Psychol 2009; 13:912-20. [PMID: 18809642 DOI: 10.1177/1359105308095065] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to investigate the effects of preferred music listening on anxiety and pain perception in patients undergoing haemodialysis. A two group experimental design was used. Sixty people diagnosed with end stage renal failure undergoing haemodialysis treatment participated in this study. Preferred music listening was applied as an intervention. Anxiety and pain were measured pre-test and post-test. The control group scored significantly higher in state anxiety than the experimental group and experienced significantly higher pain intensity in post-test phase. Findings provide experimental evidence to support the effectiveness of preferred music listening in medical settings.
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Sjöström-Strand A, Fridlund B. Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study. Int J Nurs Stud 2008; 45:1003-10. [PMID: 17803997 DOI: 10.1016/j.ijnurstu.2007.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 07/04/2007] [Accepted: 07/05/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care. AIM The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI). METHODS The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation. RESULTS The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision. CONCLUSION Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.
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Davidson P, DiGiacomo M, Zecchin R, Clarke M, Paul G, Lamb K, Hancock K, Chang E, Daly J. A Cardiac Rehabilitation Program to Improve Psychosocial Outcomes of Women with Heart Disease. J Womens Health (Larchmt) 2008; 17:123-34. [DOI: 10.1089/jwh.2007.0386] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patricia Davidson
- School of Nursing and Midwifery, Centre for Cardiovascular and Chronic Care, Curtin University of Technology, Australia
| | - Michelle DiGiacomo
- School of Nursing and Midwifery, Centre for Cardiovascular and Chronic Care, Curtin University of Technology, Australia
| | - Robert Zecchin
- Area Cardiac Rehabilitation and Chronic Care Programs, Sydney West Area Health Service, Australia
| | - Mary Clarke
- South Eastern Sydney Illawarra Area Health Service, Australia
| | - Glenn Paul
- South Eastern Sydney Illawarra Area Health Service, Australia
| | - Kate Lamb
- Area Cardiac Rehabilitation and Chronic Care Programs, Sydney West Area Health Service, Australia
| | - Karen Hancock
- School of Nursing, University of Western Sydney, Australia
| | - Esther Chang
- School of Nursing, University of Western Sydney, Australia
| | - John Daly
- School of Nursing, University of Western Sydney, Australia
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Hildingh C, Fridlund B, Lidell E. Women’s experiences of recovery after myocardial infarction: A meta-synthesis. Heart Lung 2007; 36:410-7. [DOI: 10.1016/j.hrtlng.2007.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 02/12/2007] [Indexed: 10/22/2022]
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Abstract
Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers’ knowledge of anxiety assessment and providers’ practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients’ outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.
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Affiliation(s)
- Debra K. Moser
- Debra K. Moser is a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington
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DiGiacomo M, Davidson PM, Vanderpluym A, Snell R, Worrall-Carter L. Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention. Aust Crit Care 2007; 20:69-76. [PMID: 17568535 DOI: 10.1016/j.aucc.2007.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome. DESIGN Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey. SETTING A metropolitan teaching hospital in Melbourne, Australia. PARTICIPANTS The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study. MAIN OUTCOME MEASURES Scores on Depression, Anxiety, and Stress Scale (DASS 21). RESULTS Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found. CONCLUSIONS The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended.
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Affiliation(s)
- Michelle DiGiacomo
- School of Nursing, University of Western Sydney & Nursing Research Unit, Sydney West Area Health Service, Australia.
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Moser DK, Riegel B, McKinley S, Doering LV, An K, Sheahan S. Impact of anxiety and perceived control on in-hospital complications after acute myocardial infarction. Psychosom Med 2007; 69:10-6. [PMID: 17244843 DOI: 10.1097/01.psy.0000245868.43447.d8] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We tested the hypothesis that perception of control moderates any relationship between anxiety and in-hospital complications (i.e., recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death) in patients with acute myocardial infarction (AMI). BACKGROUND Anxiety is common among patients with AMI, but whether it is associated with poorer outcomes is controversial. Conflicting findings about the relationship of anxiety with cardiac morbidity and mortality may result from failure to consider the moderating effect of perceived control. METHODS This was a prospective examination of the association among anxiety, perceived control, and subsequent in-hospital complications among patients (N = 536) hospitalized for AMI. RESULTS Patients' mean anxiety level was double that of the published mean norm. Patients with higher levels of perceived control had substantially lower anxiety (p = .001). A total of 145 (27%) patients experienced one or more in-hospital complications. Patients with higher levels of anxiety had significantly more episodes of ventricular tachycardia, ventricular fibrillation, and reinfarction and ischemia (p < .01 for all). In a multivariate hierarchical logistic regression model, left ventricular ejection fraction, history of myocardial infarction, anxiety score, and the interaction of anxiety and perceived control were significant predictors of complications. CONCLUSION Anxiety during the in-hospital phase of AMI is associated with increased risk for in-hospital arrhythmic and ischemic complications that is independent of traditional sociodemographic and clinical risk factors. This relationship is moderated by level of perceived control such that the combination of high anxiety and low perceived control is associated with the highest risk of complications.
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Affiliation(s)
- Debra K Moser
- University of Kentucky, College of Nursing, Lexington, Kentucky 40536-0232, USA.
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Affiliation(s)
- Marla J De Jong
- University of Kentucky, College of Nursing/United States Air Force, Lexington, Ky, USA.
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Hirakawa Y, Masuda Y, Uemura K, Kuzuya M, Kimata T, Iguchi A. Differences in in-hospital mortality between men and women with acute myocardial infarction undergoing percutaneous coronary intervention in Japan: Tokai Acute Myocardial Infarction Study (TAMIS). Am Heart J 2006; 151:1271-5. [PMID: 16781235 DOI: 10.1016/j.ahj.2005.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 06/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is a matter of concern that women have higher in-hospital mortality rates than men with percutaneous coronary intervention (PCI); however, it is not yet clear whether significant sex differences exist. This study aimed to determine if there are sex differences in the characteristics and in-hospital mortality among patients with acute myocardial infarction (AMI) undergoing PCI in Japan. METHODS We used data from 13 acute care hospitals in the Tokai region (central Japan) included in the sample from the TAMIS, a retrospective study of all patients admitted to these hospitals from 1995 to 1997 with a diagnosis of AMI. We abstracted the baseline and procedural characteristics from detailed chart reviews which included not only physician notes but also nursing notes, and a questionnaire included baseline characteristics, procedural course, and in-hospital mortality. Multivariate analysis was performed, controlling for age and other variables which were found to be significantly different between men and women by chi2 test or Mann-Whitney U test. RESULTS In TAMIS, we had a total of 2020 subjects. A total of 303 women and 1033 men undergoing PCI were included in the present study. There were sex differences in age, comorbid conditions, smoking status, activities of daily living, and heart failure on presentation. In univariate analysis, women had a higher in-hospital mortality rate than men; however, this sex difference disappeared after multivariable adjustment. CONCLUSIONS Our study demonstrates that women with AMI who undergo PCI do not have a significantly higher in-hospital mortality rate than men in Japan; additional larger-scale studies are needed to confirm these results.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
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Michalsen A, Grossman P, Lehmann N, Knoblauch NTM, Paul A, Moebus S, Budde T, Dobos GJ. Psychological and quality-of-life outcomes from a comprehensive stress reduction and lifestyle program in patients with coronary artery disease: results of a randomized trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 74:344-52. [PMID: 16244510 DOI: 10.1159/000087781] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD). METHODS 101 patients (59.4 +/- 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures. RESULTS Adherence to the program was excellent (daily relaxation practice 39 +/- 5 vs. 5 +/- 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention x gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men. CONCLUSIONS A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.
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Affiliation(s)
- Andreas Michalsen
- Kliniken Essen-Mitte, Chair of Complementary and Integrative Medicine of the University Duisburg-Essen, Department of Internal Medicine V and Integrative Medicine, Essen, Germany.
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Hirakawa Y, Masuda Y, Uemura K, Kuzuya M, Kimata T, Iguchi A. Age-related differences in the delivery of cardiac management to women versus men with acute myocardial infarction in Japan: Tokai Acute Myocardial Infarction Study: TAMIS. Int Heart J 2006; 46:939-48. [PMID: 16394590 DOI: 10.1536/ihj.46.939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, >or= 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI, 0.35-0.82). After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Japan
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Abstract
Coronary artery disease in women is associated with higher morbidity and mortality than in men. The purpose of this article is to summarize recent literature concerning gender-based differences. Specific differences in pathophysiology, traditional and psychosocial risk factors, symptom presentation, treatments, and outcomes between women and men will be reviewed.
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De Jong MMJ, An K, McKinley S, Garvin BJ, Hall LA, Moser DK. Using a 0-10 Scale for Assessment of Anxiety in Patients With Acute Myocardial Infarction. Dimens Crit Care Nurs 2005; 24:139-46. [PMID: 15912064 DOI: 10.1097/00003465-200505000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) often experience anxiety, an emotion that predicts adverse physiologic outcomes. The purpose of this study was to determine whether a single-item anxiety assessment instrument, the Anxiety Level Index (ALI), is a valid alternative to the State Anxiety Index (SAI) or the anxiety subscale of the Brief Symptom Inventory (BSI) for assessing state anxiety for patients with AMI. In this prospective multicenter study, 243 inpatients with AMI rated their anxiety using the SAI, the anxiety subscale of the BSI, and the ALI. Anxiety Level Index scores were compared to SAI and BSI anxiety subscale scores. There were moderate, positive correlations between the SAI and the ALI (rs = 0.52, P < .001), and between the ALI and the anxiety subscale of the BSI (rs = 0.45, P < .001). Although ALI scores were moderately and significantly correlated with scores on the SAI and the BSI anxiety subscales, the results of the Bland-Altman method indicate a lack of construct validity of the single-item measure. The quest continues to construct a simple self-report measure of anxiety that is appropriate for critically ill patients with AMI.
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Abstract
Although the influence of gender and ethnicity on cardiovascular disease has been understudied, cardiovascular nurse researchers have contributed significantly to the existing body of knowledge. This article distinguishes between the constructs of "gender versus sex'' and "ethnicity versus race,'' acknowledging that the terms are often used interchangeably in research. A sampling of the substantial contributions of cardiovascular nurse researchers related to gender and ethnicity in the areas of symptoms of cardiovascular disease; risk factors and prevention; delay in seeking care, diagnosis, and treatment; recovery and outcomes; and cardiac rehabilitation is highlighted. Recommendations for future research include publishing research data by gender and ethnicity subgroups even though statistical comparisons may not be feasible, and increasing cardiovascular disease research in minority populations such as Asian Americans, Pacific Islanders, Native Americans, and Hispanics. Finally, we challenge cardiovascular nurse researchers to shift from the documentation of disparities toward designing and testing of interventions to eliminate health disparities.
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Affiliation(s)
- Jerilyn Allen
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
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