The psychological and social effects of myocardial infarction on wives

Factors Affecting Anxiety and Depression Symptoms in Relatives of Intensive Care Unit Patients

Aim:

To determine the incidences of anxiety and depression in relatives of patients admitted to an intensive care unit (ICU) and to investigate the relationships between psychological symptoms and demographic features of the patients and their relatives.

Methodology:

Relatives of 78 ICU patients were enrolled in the study. Sociodemographic features of patients and their relatives were recorded. The Turkish version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression.

Results:

Twenty-eight (35.9%) cases with anxiety and 56 (71.8%) cases with depression were identified. The mean anxiety and depression scores were 9.49 ± 4.183 and 9.40 ± 4.286, respectively. Anxiety ( P = .028) and concomitant anxiety with depression ( P = .035) were more frequent among family members of young patients. The relationship to the patient, especially being a spouse, was significantly associated with symptoms (anxiety, P = .009; depression, P = .019; and both, P = .005).

Conclusion:

Spouses and family members of relatively young patients had higher rates of anxiety and depression. In contrast to the literature, depression was more common than anxiety among the relatives of ICU patients. Further research is needed on the impact of cultural and regional differences on anxiety and depression rates in family members of ICU patients.

Relationship between Husband's Health Status and the Mental Health of Older Women

This study examines the association between husband's health and the mental health of community-dwelling White women 65 to 75 years of age and how the wife's health, socioeconomic and social resources, and marital quality affect this relationship. Husband's health strongly predicts wife's mental health; the negative impact of which is more pronounced when the wife has poor or declining health as well. Marital quality is a strong predictor of the wives' mental health. Analyses examining the independent and joint effects of marital quality and husband's health on wife's mental health indicate that the negative association of illness in a spouse on wife's mental state is, in part, a function of the impact husband's health has on marital intimacy and shared pursuits. Of the socioeconomic and social resources examined, only availability of close friends shows a substantial relationship to the wives' mental health.

Symptoms experienced by family members of patients in intensive care units

Concern for the family members of patients who are at high risk of dying in intensive care units is both a necessary and integral part of providing holistic nursing care. When patients are at high risk of dying, their families experience burdens such as decision making and treatment choices that can cause the families psychological and physical symptoms, most commonly stress, anxiety, and depression. These symptoms in turn can affect family members' general well-being. Since the late 1990s, several quantitative and qualitative studies have been done to assess symptoms in such family members. In this review of the literature, the current state of the science on symptoms experienced by family members of patients in the intensive care unit is reviewed and critiqued. Risk factors associated with an increase in symptoms experienced are discussed. Overall, surveys that use self-report measures were the most common study design. Limitations of the studies include convenience sampling, small sample sizes, and a lack of description of patients' characteristics, all of which make comparison and use of findings difficult. Recommendations to address gaps in the literature are highlighted, and future research goals are discussed.

Impact of cardiac disease on couples' relationships

AIM

This paper reports a study to describe meanings that couples mutually assign to, and practices they develop, after the onset of cardiac disease and to understand the impact of the illness on the couples' relationships in everyday life.

BACKGROUND

Patients as well as partners are affected by the onset of cardiovascular disease. Social support within intimate relationships has been shown to be important for patient survival and well-being, and couples' coping strategies are pivotal for well-being and adjustment to the chronic condition in both patients with cardiovascular disease and their partners.

METHOD

Twenty-four couples participated in this phenomenological study. Data were collected during 2003. Participants were interviewed after having been hospitalized due to an acute event and having participated in a rehabilitation programme. Three in-depth interviews were obtained for each dyad: one couple interview and two individual interviews with each partner of the dyad. Paradigm cases were sought and thematic analyses conducted.

FINDINGS

All couples experienced a 'brush with death' at the onset of heart disease, which called for changes in lifestyle. Three distinct patterns of dealing with the illness emerged. The first revealed that some couples assess the illness as a positive, transformative experience in their lives, bringing them closer together. The second showed that a proportion of couples experience the illness as a threat which imposes fear on both partners. The challenges are faced as mutual tasks and new routines are developed. The third pattern revealed couples who experience a missed opportunity to change. These couples are disenchanted about each other but return to life as usual.

CONCLUSIONS

Nurses can use the information gained from this study to support couples in their attempts to come to terms with the illness, and can enhance their supportive role in rehabilitation efforts.

[Which kinds of distress do partners or spouses of cardiac arrhythmias patients exhibit?]

OBJECTIVES

Partners or spouses of patients with cardiac arrhythmias were examined for mental and physical health. In addition, gender differences and other influential factors of well-being were analyzed.

METHODS

A total of 486 partners or spouses took part in a study which collected data on anxiety and depression (HADS-D) as well as quality of life (SF-12). The situation of the partners was correlated with social variables, psychological distress, and the physical and mental well-being of the patients.

RESULTS

Pathological anxiety was reported by 20 percent of the partners and 37 percent demonstrated notable values for depression. In comparison to healthy samples quality of life was diminished, especially in male subjects. There was a strong inter-connection between the patient's psychological strain and that of his or her partner. Most important for the partner's physical quality of life was the patient's quality of life (18.4% explained variance). The partner's mental well-being was determined by his or her own psychological distress (31.1% explained variance).

CONCLUSION

Spouses and partners of patients with cardiac arrhythmias are highly impaired in their psychological well-being. This should be taken into account when dealing with medical care issues in such patients. It is therefore important to inform patients and their families in detail about the potential risks as well as the options for relatives' responses in arrhythmia-induced emergencies.

Family caregiving and congestive heart failure. Review and analysis

BACKGROUND

There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heart failure (CHF) in the community and that the quality of the CHF patient's close personal relationships can influence outcome in CHF. However, there has been little research on the impact of CHF on the family or the role of the family in the management of the condition. In this paper, we provide a review and analysis of studies that have explicitly investigated these issues in the informal carers of CHF patients.

RESULTS OF THE REVIEW

Sixteen papers were identified that examined the role and/or impact of informal caregiving for CHF patients. Our main findings were: demands specific to CHF caregiving were identified, e.g., monitoring complex medical and self-care regimen, disturbed sleep and frequent hospitalisation of patients. Relatively high levels of emotional distress were identified in CHF caregivers. Few studies explicitly investigated the role of informal carers in the management of CHF. Studies were limited in number, scope and quality.

CONCLUSION

Caring for a family member with CHF can affect the well-being of those responsible for care, which may have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF in the community.

Role of spousal anxiety and depression in patients' psychosocial recovery after a cardiac event

OBJECTIVE

The purposes of this study were to a) compare emotional responses and perception of control of patients and their spouses to myocardial infarction or coronary revascularization; and b) examine the relationship between spouses' emotional distress and patients' emotional distress and psychosocial adjustment to the cardiac event.

METHODS

A total of 417 patient-spouse pairs were recruited after the patient was hospitalized for either acute myocardial infarction or coronary revascularization. We compared emotional responses of patients and spouses. The relationship between spouse anxiety and depression, and patient psychosocial distress was then determined.

RESULTS

Spouses had higher levels of anxiety (p <.001) and depression (p <.001) than did patients, but there were no differences in level of hostility. Patients also expressed higher levels of perceived control than did spouses (p <.001). Spouse anxiety, depression, and perceived control remained correlated with patient psychosocial adjustment to illness, even when patient anxiety and depression were kept constant. Patients' psychosocial adjustment to illness was worse when spouses were more anxious or depressed than patients, and it was best when patients were more anxious or depressed than spouses, whereas psychosocial adjustment to illness was intermediate to these 2 extremes when patient and spouse anxiety and depression levels were similar (p =.001).

CONCLUSION

Spouses often experience greater anxiety and depression and less perceived control than patients themselves. Attention to the psychological distress experienced by spouses of patients who have suffered a cardiac event may improve outcomes in patients.

Marital satisfaction of wives of untreated sleep apneic men

OBJECTIVES

The purpose of this study was to assess marital satisfaction of the wives of untreated sleep apnea patients.

DESIGN AND METHODS

A prospective study was carried out that compared the marital satisfaction of wives of men with sleep apnea to the marital satisfaction of wives of men presenting to a primary care physician's office. The study examined three patient groups: 26 wives of men with severe sleep apnea, 19 wives of men with mild sleep apnea, and 19 controls from a primary care physician's office. Those with other significant medical disorders were excluded. Marital satisfaction using the Dyadic Adjustment Scale and a sleep behaviors questionnaire was compared between the patient groups.

RESULTS

Wives of severe and mild apneic men were similar to controls on marital satisfaction but differed significantly in satisfaction with husbands' sleep behaviors.

CONCLUSIONS

Although the presence of sleep apnea in married men has little effect on their wives' overall marital satisfaction, it did affect whether they slept together or apart. For these patients, the choice to sleep apart may have benefited rather than impaired marital satisfaction.

Coping in spouses of patients with acute myocardial infarction in the early phase of recovery

The purpose of this study was (1) to determine the coping strategies employed by spouses of patients with AMI in the early phase of the crisis, (2) to define the role of age, gender, health perception, time since infarction, spouses' fears, and negative life events in the choice of coping strategies applied, and (3) to test the effect of coping strategies on physical and psychological strain. Fifty-seven spouses participated in the study, 47 were female and 10 were male. Data were collected by structured questionnaires, which were distributed to the spouses from 2 weeks-4 months after the patient's AMI. The researchers found that age, negative life event during the last 12 months, time since infarction, and the spouse's fears influenced the choice of strategies. In the early stage of the crisis, positive reappraisal seems to be a strategy that increased physical strain. Spouses' need for social support in the early stage of the crisis is a factor for health care providers to bear in mind. Besides giving information, empathy, and understanding, health care personnel can try to assist spouses in their efforts to reappraise their situation.

Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients

The objectives of this study were to determine whether there are differences in emotional distress among spouses of recovering cardiac patients based on level of perceived control, and to determine whether perceived control can be enhanced by cardiopulmonary resuscitation (CPR) training. A total of 219 spouses of cardiac patients recovering from an acute cardiac event were enrolled and 196 completed the study. Spouses were assigned to either a no-treatment control group or one of two CPR training groups. Perceived control and emotional adjustment were measured at baseline and again 1 month after subjects received CPR training. Spouses with high perceived control were less anxious, less depressed, and less hostile at baseline. Perceived control increased significantly in spouses after both CPR training groups, but was unchanged in the control group. After a partner's cardiac event, perceived control is important for psychological recovery in spouses and can be increased by CPR training.

Acute myocardial infarction in middle-aged women: narrations from the patients and their partners during rehabilitation

The purpose of this study was to examine the meaning of lived experiences after an acute myocardial infarction (AMI) and being a partner to an afflicted woman, as it is narrated during rehabilitation. Nine women and their partners narrated their experiences three and twelve months after AMI. The interview texts were transcribed and then interpreted, using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. The result showed that their experiences of the illness contained two themes: 'rehabilitation needed' and 'loss of freedom' which contains eight sub-themes; 'adapting to it', 'struggling against it', 'living as normally as possible', 'having insight into how it can be', 'feeling guilty and ashamed about being weak', 'withholding feelings', 'feeling useless', and 'feeling fatigued and losing strength'. After further interpretation, the themes gave a deeper meaning of living with AMI and how it affects women and their partners. The women conceded that they felt distressed and vulnerable but struggled against the fear the illness means. The partner's role appears to be one of trying to adapt to the women's experiences of the illness. That the women withheld their feelings and did not talk about them indicates a lack of communication between the couples. As coronary care nurses often come very close both to the afflicted persons and the relatives they fill an important function in each patient's recovery. The nurses could help and prepare the patients and their relatives to understand better such feelings and reactions as could appear after discharge from hospital.

Patients' and carers' perceptions of factors influencing recovery after cardiac surgery

Stress and anxiety experienced by patients following myocardial infarction are well documented. Moreover, partners feel distress when they realize that they must assume responsibility for day-to-day care once the period of hospitalization is over. However, despite the trend towards early hospital discharge and the role which carers appear to be expected to undertake during the recovery of patients who have had cardiac surgery, few studies have been undertaken with this group outside the United States of America. This omission was filled by a descriptive survey with 60 patients and carers following cardiac surgery. Data were obtained during early recovery (1 week after hospital discharge) and 6 weeks later. The results indicated that carers assumed a heavy burden once the patient had left hospital and were less satisfied with the timing of discharge than the patients. Information provided by nurses was consistently rated more highly than information provided by doctors or physiotherapists but there was scope for increasing input with both groups. High levels of satisfaction with the information provided by health professionals were associated with lower scores on the Hospital Anxiety and Depression Scale. More qualitative, in-depth studies to explore the precise needs of patients and their carers are needed to ensure that in future both groups are better prepared.

Carers' opinions and emotional responses following cardiac surgery: cardiac rehabilitation implications for critical care nurses

The recent joint position statement made by the RCN Critical Care and Rehabilitation Nursing Forums highlights the need for rehabilitation to commence early. This paper reports the findings of a descriptive survey of 59 carers of cardiac surgery patients and presents implications for cardiac rehabilitation. Data were obtained by postal questionnaire during early recovery (one week following discharge) and six weeks later. The questionnaire explored carers' perceptions about the timing of discharge from hospital; opinions of the information provided by hospital staff; and anxiety and depression measured on the Hospital Anxiety and Depression Scale. The results indicated that carers assumed a heavy burden once the patient had left the specialist cardiac centre. Carers responding at one week were less satisfied with the timing of discharge than those questioned at six weeks. Information provided by nurses was rated more highly than that provided by doctors or physiotherapists. However, there was scope for increasing input. The findings suggest that cardiac rehabilitation needs to be aimed at carers as well as patients. Investment in targeted carer support could facilitate patient recovery and rehabilitation. Strategies aimed at the carer need to begin early and commence during the acute stage of the patients' recovery.

Myocardial infarction, spouses' reactions and their need of support

The purpose of this study was to investigate the impact of myocardial infarction (MI) on survivor's spouses in terms of fears and symptoms during the patient's recovery period. In addition the researchers sought to evaluate the influence of the support by the health care professionals on spouses' adjustment. A total of 57 Finnish spouses participated in the study. Of the spouses 47 were female and 10 were male. Data were collected using a structured questionnaire distributed to the spouses at a rehabilitation session at 2 weeks-4 months after the MI. Topics covered included fears, emotional and physical symptoms and the spouses' experience of the sufficiency of the support that they had received from health care professionals during the patient's recovery. Data were analysed using quantitative methods including descriptive statistics and multivariate methods. Fears and symptoms were classified using factor analyses. For fears two factors emerged which were named: disease-related fears and personal fears. In respect of symptoms experienced by the spouse three factors emerged: one which describes emotional distress, one which describes dysfunction and one describing spouses' own vulnerability. The significantly most intensively experienced fears by the spouses were the disease-related fears followed by the personal fears. The most frequently reported symptom was dysfunction followed by emotional distress and vulnerability. In regression analysis emotional distress was predicted by personal fears, support from the health care professionals, the shock reaction, spouse's own health and time after MI. Dysfunction was predicted by spouse's own health and personal fears whereas vulnerability was predicted by spouse's own health and support from the health care professionals. Study findings show that in the planning of the care of patients with MI it is important to attend to the reactions and needs of spouses. Their resources are required for optimal rehabilitation of the patient.

The experiences of female spouses of survivors of acute myocardial infarction: a pilot study of Lebanese-born women in south-western Sydney, Australia

Lebanese migrants form a significant proportion of the population in southwestern Sydney (SWS), and in New South Wales, Australia. This pilot study was undertaken in south-western Sydney, a rapidly expanding and socioeconomically disadvantaged region, to explore the experiences of English speaking women of Lebanese origin whose spouses had recently experienced an acute myocardial infarction (AMI). Semi-structured interviews were conducted with seven Lebanese-born women at 2- and 4-week intervals, following the discharge of their husbands from hospital. Qualitative analysis of narrative text revealed four distinct themes. These were: struggle to resolve distress; intensive monitoring of the AMI survivor; searching for avenues of support; and reflecting on the future. Study findings are discussed in relation to the literature. Implications for nursing practice and research are drawn from study findings.

Life after a myocardial infarction--the wives' point of view

37 wives of patients with myocardial infarction (MI) were interviewed after the index MI to examine the consequences with regard to quality of marital relationship, symptoms of distress, worries and concerns and to evaluate the long-term outcome from the wives' personal point of view. The interviews were done at three times: during hospitalisation, three months after discharge, and 10 years post index MI. Our findings suggest relatively minor and time-limited adjustment problems concerning marital relationship and symptoms of distress. In a long-term perspective, only a few lasting changes were found. On the other hand, the wives' subjective assessment of the long-term effects of the infarct within different domains of life indicated that the illness episode had a comprehensive negative influence on their quality of life. In accordance with this, the majority reported that the myocardial infarction was still not a closed episode.

In the shadow: the impact of chronic illness on the patient's partner

This study focuses on the partners of patients with chronic illness. Through intensive interviews with the patients' partners and their general practitioners (GPs), the problems the partners experience are explored and analyzed in terms of the support the GP may provide. A description is given of the main problems partners of chronically ill patients have to cope with and the tasks these imply for their everyday life. The attitude and communication skills of the GP are a key factor in whether he or she will play an important supporting role in the case of chronic illness in the family.

Evidence for the effectiveness of cardiac rehabilitation

Cardiac rehabilitation is a relatively recent development and, though it is increasingly being recognized as an important part of comprehensive cardiac care, there remains some scepticism regarding its effectiveness and some ignorance of its potential. This article reviews the literature pertaining to the effectiveness of cardiac rehabilitation for patients with coronary heart disease (CHD).

Cardiac spouses' help-seeking experiences

The purpose of this study was to investigate the phenomenon of help seeking by spouses of cardiac rehabilitation patients by eliciting their verbal description of the experience. A phenomenological approach was used to collect data that consisted of individual interviews and focus group interviews. The exhaustive description of the phenomenon of help seeking described how the spouses' views of the illness affected initiation of help seeking. Spouses' stories revealed three time periods when spouses needed help: diagnosis, a time of uncertainty and loss of control; hospitalization, a time of information seeking and vigilance; and homecoming, a time of active help seeking because control is regained. To manage the uncertainty, spouses sought meaningful information to contend with difficulties. Spouses told of the individuals who assisted most, of barriers to seeking help, and availability of resources for support. This study increases health care providers' understanding of spouses' experiences, which may facilitate design of interviews that maximize supports for spouses. Assisting spouses will subsequently improve patients' recovery and facilitate lifestyle changes.

Hiding worries from One's spouse: associations between coping via protective buffering and distress in male post-myocardial infarction patients and their wives

The relationship between protective buffering, a style of coping in which the individual hides his/her concerns from spouse, and level of distress was studied among post-myocardial infarction (MI) patients and their spouses. Forty-three male married MI survivors and their wives completed measures of psychological distress and protective buffering at 4 weeks and 6 months post-hospital discharge. At both time periods, a greater propensity for protective buffering by the patient was related to higher levels of patient distress. Protective buffering by wife was also associated with higher levels of wife distress. In addition, patient buffering at 4 weeks predicted increased patient distress at 6 months. The results suggest that male MI patients who conceal their worries from their spouses adjust more poorly over time.

The effects of caring for a spouse with Parkinson's disease on social, psychological and physical well-being

BACKGROUND

Several previous studies have examined the health of carers, but they have usually focused on elderly subjects and have often not had representative control samples.

AIM

To determine whether caring for a partner with Parkinson's disease is associated with a worsening social, psychological and physical well-being than people with partners who do not suffer with Parkinson's disease.

METHOD

One hundred and fifty-four carer spouses of subjects with Parkinson's disease, and 124 non-carer spouses of randomly selected population controls recruited from a national case-control study of early-onset Parkinson's disease in the Republic of Ireland, between 1992-1994, were studied. Outcome was measured along three dimensions: social functioning, assessed by the frequency of social contacts, outings and holidays; psychological well-being, measured by the General Health Questionnaire; and physical health, measured by the career's use of medical services, medications and episodes of chronic illness.

RESULTS

Carer spouses were less likely to get out of the house once a week at least (odds ratio 1.79, 95% confidence intervals 1.00-3.20) or to have had a holiday in the last year (odds ratio 1.71, 95% confidence intervals 1.01-2.90). Contact with friends and neighbours decreased with increasing care provision. For spouses providing a lot of care, there was an almost fivefold increase in psychiatric morbidity (odds ratio 4.86, 95% confidence intervals 1.5-15.9) after adjusting for other variables. Most of the medical outcomes were less favourable among carers, but only the use of tranquilizers (odds ratio 3.73, 95% confidence intervals 1.18-11.8) and episodes of chronic illness (odds ratio 2.96, 95% confidence intervals 1.27-6.94) were significant.

CONCLUSIONS

Overall, career spouses have slightly worse social, psychological and physical profiles. For social outcomes, increasing care provision is associated with fewer contacts, outings and holidays. For psychological and physical measures, carers providing a lot of care experience worse health. These results have implications for targeting appropriate interventions.

Spouse stressors while awaiting heart transplantation

OBJECTIVES

The objectives of this study were to identify common stressors experienced by spouses of heart transplantation (HT) candidates; to identify differences in stressors among spouses of HT candidates based on selected demographic variables; and to report preliminary psychometric data on the newly developed Spouse Transplant Stressor Scale.

DESIGN

Comparative, cross-sectional survey.

SAMPLE

Spouses of 85 HT candidates awaiting HT at midwestern and southeastern medical centers and a midwestern Department of Veterans Affairs hospital.

MEASURES

Spouse Transplant Stressor Scale (Collins), an investigator-developed rating form and demographic data sheet.

RESULTS

Spouses of HT candidates reported high levels of stress during the wait for a donor heart. Factors related directly to the transplantation experience were rated as the most stressful. Fear that the patient (partner) would die before a heart became available was the worst stressor for the spouses. Working spouses perceived more stressors related to responsibility, socioeconomics, and self. Stressors associated with the transplantation process itself were equally stressful for spouses who work and spouses who do not work.

Bibliotherapy for psychosocial distress in lung transplant patients and their families

Thirty-six lung transplant candidates (n = 16), recipients (n = 11), and support people (n = 9) were examined for psychological distress, coping style, and orientation to independent learning before and after receiving a self-help book in a program designed to alleviate psychosocial distress and bolster adaptive coping. The subjects rated the book as highly acceptable, and none reported increased psychological distress. A further six subjects completed initial psychological measures but elected not to us the book. These subjects were compared with study completers and found to have significantly higher disengagement scores on the Coping Strategies Inventory. Although uncontrolled, significant changes were observed in coping strategies used by the completer group. The relevance of these findings to the use of bibliotherapy in medically ill populations is discussed.

Nurse-initiated telephone follow-up after acute myocardial infarction: a pilot study

OBJECTIVES

To determine the receptivity of patients with acute myocardial infarction and their spouses to postdischarge follow-up telephone calls from a nurse, and to describe the content of nurse-patient/spouse telephone conversation during early convalescence at home.

DESIGN

Descriptive pilot study using qualitative methods.

SETTING

University medical center and home.

SAMPLE

Twenty-one male patients with acute myocardial infarction and their wives who agreed to participate in the study.

RESULTS

All subjects were receptive to telephone follow-up by cardiac nurse clinicians. From data analysis of telephone calls, five content themes emerged. These included (1) difficulty accepting changed health status, (2) reports of attempts at risk factor reduction, (3) concern for financial difficulties, (4) dealing with uncertainty, and (5) expression of appreciation for the nurse-initiated telephone call. Nurse investigators provided information and emotional support and made referrals.

CONCLUSIONS

Further research should be done to test the feasibility and effectiveness of nurse-initiated telephone follow-up after hospital discharge for acute myocardial infarction in reducing patient and spouse stress and increasing patient/spouse information about self-care regimens. The clinical trial should also determine whether telephone follow-up by nurse increases patient satisfaction with the health care delivery system.

Effect of premature myocardial infarction in men on the eating habits of spouses and offspring

OBJECTIVE

To investigate whether family members comply with a healthier diet after the father has had a myocardial infarction.

DESIGN

Cohort study with administration of a dietary history questionnaire.

SETTING

Outpatient lipid research clinic, Cincinnati, Ohio.

SUBJECTS

Male subjects (referred to as father) who had had myocardial infarction before age 56 years were recruited along with their spouse and at least one offspring (myocardial infarction [MI] group; n = 136). Control families (comparison group; n = 237) were also recruited.

STATISTICAL ANALYSES

The t test, analysis of covariance, analysis of variance, least-squares means, chi 2, and Kruskal-Wallis.

RESULTS

Significant differences in dietary intake were found for percentage of energy from total and saturated fat (P < .0001), ratio of polyunsaturated fat to saturated fat (P:S ratio) (P < .0001), and cholesterol intake (P = .001) between fathers in the MI and comparison groups. The fathers in the MI group consumed 4.5% and 2.6% less energy from total and saturated fat, respectively, and less cholesterol (135 vs 151 mg/1,000 kcal) and demonstrated a higher P:S ratio (0.76 vs 0.62) than the fathers in the comparison group. Spouses in the MI group consumed less total energy (P = .02) and less energy from fat and saturated fat than spouses in the comparison group (P = .04 and P = .004, respectively). When spouses were grouped by time since the father's myocardial infarction, no differences were found in energy from saturated fat intake between the comparison population and those spouses 3 years or more after the myocardial infarction. The diet of the offspring in the MI group closely resembled that of the offspring in the comparison group.

CONCLUSIONS/APPLICATIONS

Fathers who had experienced a myocardial infarction complied with a diet lower in fat and cholesterol than did fathers in a control comparison group. Spouses only complied with an improved diet for an initial period after the cardiac event. The cardiac event demonstrated little to no effect on the diet of the offspring. Offspring who have a high risk for cardiovascular disease, as well as the parents, need to be educated about the importance of establishing and maintaining a proper dietary regimen.

Partners in adversity. III. Mood status after the event

This paper presents further results from a longitudinal study of three groups of married women undertaken in Edinburgh. Each group shared a common stressful experience. In the first group the marital partner had recently died; in the second the marital partner had recently experienced a myocardial infarction (MI) and the third group consisted of women recently entering a Women's Aid refuge. Interviews were completed shortly following the adverse experiences and where possible again about 3 months later. This report presents details of the (self-reported) mood status of the respondents at both assessment occasions in terms of the degree, form and change in symptomatic distress over what were equivalent time periods for the three groups. Mood status was determined on the basis of the conventionally scored 30-item GHQ (General Health Questionnaire) and according to a criterion-based scoring procedure. On this basis at initial interview almost 8 out of 10 of the widows were above the advised GHQ cut-point, almost 6 out of 10 of the refuge seekers and over 4 out of 10 of the coronary wives. At follow-up these proportions had almost halved for the widows and coronary wives but had changed very little for those few refuge-seekers successfully re-interviewed. According to a criterion-based measure at initial interview, the recent widows had an anxiety rate 5.2 times and a depression rate ten times that of a general population sample of women. Details of the changes in mood status amongst the groups over the follow-up are presented.

Toward a model for quality assessment in heart transplantation

A model for quality assessment of heart transplantation that combines a scientific method for studying the recipients' quality of life and a basis for a method of clinical work by nurses and other health care professionals is discussed. Besides its use as a research method, this model also may serve as an instrument for documenting patients' biopsychosocial status, including coping capacity, and for evaluating nursing interventions.