Assessment of hostility in patients with coronary heart disease

Depression predicts perioperative outcomes following coronary artery bypass graft surgery

OBJECTIVES

To assess preoperative depression in middle-aged men undergoing coronary artery bypass graft surgery (CABG) and to determine if depression is related to perioperative outcomes.

DESIGN

One hundred and nine middle-aged male patients were randomly selected and assessed for depression one day before CABG using the Symptom Checklist-90 Revised (SCL-90R). Perioperative outcomes were: (1) postoperative length of hospital stay, (2) the presence of any early complications (at intensive care unit), and (3) the presence of any late complications (at cardiac surgery unit).

RESULTS

Twenty-five (23%) patients had a high level of depression. Preoperative depression scores significantly predicted postoperative length of hospital stay (p < 0.001) and the incidence of late perioperative complications (p < 0.05) independently from biomedical and sociodemographic factors. Each increase in depression T score increased the odds of occurrence of late complications by 10% (p = 0.018, CI 95% 1.02-1.19).

CONCLUSIONS

Depression is common in middle-aged men undergoing CABG and is an independent predictor of postoperative length of hospital stay and late perioperative complications.

Assessing alexithymia and type A behavior in coronary heart disease patients: a multimethod approach

BACKGROUND

Despite increasing emphasis on using multiple methods to assess personality constructs in psychosomatic research, previous investigations of relations between alexithymia and type A behavior (TAB) have been limited by the use of single methods of measurement and almost no attempt to assess subcomponents of TAB. The aims of this study were to (1) evaluate levels of agreement between structured interview assessments of alexithymia, TAB, hostility, and time urgency and well-established self-report measures of these constructs, and (2) explore relations between alexithymia and TAB and its subcomponents in patients with coronary heart disease (CHD).

METHODS

62 CHD patients were investigated 6 weeks after coronary angioplasty. Alexithymia was assessed with the Diagnostic Criteria for Psychosomatic Research (DCPR) and the 20-item Toronto Alexithymia Scale (TAS-20). TAB was assessed with the DCPR and the Short Form of the Jenkins Activity Survey Type A scale (JAS-SF). Time urgency was assessed with the DCPR and the Speed/Impatience scale of the Jenkins Activity Survey (JAS-S), and hostility was assessed with the DCPR and the Hostility subscale of the Revised Symptom Checklist-90 (SCL-HOS).

RESULTS

The DCPR classifications showed reasonably high levels of agreement with the TAS-20 and JAS-SF classifications of alexithymia and TAB, but lower levels of agreement in identifying patients with high hostility on the SCL-HOS and high time urgency on the JAS-S. Alexithymia measured by both the DCPR and the TAS-20 was unrelated to both self-report and structured interview measures of TAB, hostility, and time urgency.

CONCLUSIONS

The DCPR is a suitable screening instrument for assessing alexithymia and TAB, although the two constructs are unrelated.

Depression, Hostility, and Social Isolation in Patients with Coronary Artery Disease

Psychosocial risk factors such as depression, hostility, and social isolation are substantially more prevalent in patients with coronary artery disease (CAD) than is widely recognized. It has been demonstrated that patients with CAD who have these risk factors, individually or together, may have a substantially increased risk for recurrent ischemic events, as well as cardiac death, when compared with unaffected CAD patients. Numerous adverse physiologic changes that appear to occur as a consequence of these psychosocial risk factors have been identified, including increased platelet aggregation, hyperadrenergic states, elevated cortisol levels, abnormal endothelial function, and an increased propensity towards malignant ventricular arrhythmias. Each of these may explain the increased risk of recurrent coronary events (including death) among afflicted patients. Under-recognition, and hence under-treatment, remains a principal obstacle for improvements in the care of patients with CAD who have psychosocial risk factors. The diagnosis of psychosocial risk factors depends on systematic patient evaluation by experienced clinicians trained in the recognition of these disorders. All clinicians must be aware of the potential importance of these factors, their sometimes subtle presenting characteristics, and the available treatment options. The universal use of comprehensive cardiovascular rehabilitation offers the ideal conduit for such evaluation and management. Nonpharmacologic therapies for psychosocial risk factors include psychotherapy, stress-reduction techniques, and exercise therapy. Studies suggest that the reduction of social isolation among depressed patients with CAD may result in a reduced mortality rate in comparison with those without improvements in isolation. Pharmacologic therapies are mainly for the management of depression, and largely center on the use of selective serotonin reuptake inhibitors (SSRIs). Several SSRIs (paroxetine and sertraline) recently have been shown to be safe and effective for the treatment of depression in patients with ischemic heart disease. Whether use of antidepressants attenuate the increased cardiac risk from depression in the setting CAD remains to be proven; however, their use improves the quality of life in properly selected patients.