Spontaneous, elicited and cued causal attributions in the year following a first myocardial infarction

Adjustment Mechanisms in the Acute Phase of Myocardial Infarction in Men

AIM

Stress and Coping Model and Post-Traumatic Growth Theory indicate adjustment procedures concepts after a crisis. The objective of this study was to assess the relationships between causal attributions, coping strategies and post-traumatic growth in male patients with acute myocardial infarction and variable cardiac function severity.

METHODS

Seventy-eight male patients surviving a myocardial infarction, were divided into two sub-groups based on left ventricular ejection fraction measurements [Group A (left ventricular ejection fraction: <45%, n = 34), Group B (left ventricular ejection fraction: ≥45%, n = 44)] and were interviewed after the acute phase of myocardial infarction, on the last day of their coronary unit stay. Medical data was obtained from their medical records. Causal Attributions' List, Coping Orientation to Problems Experienced and Post-Traumatic Growth Inventory were used.

RESULTS

Causal attributions were found to be related to active coping, emotional support, religious coping and self-blame in both groups. Planning, positive reinterpretation and active coping were the strategies associated positively with most of the post-traumatic inventory subscales in total data analyses.

CONCLUSIONS

Diverse coping strategies were associated with posttraumatic growth factors. It is important to assess adjustment mechanisms in the acute phase of myocardial infarction. A tailored scheme therapy, considering patient's needs, has to be planned.

Classification of illness attributions in patients with coronary artery disease

OBJECTIVE

To examine patient-reported causal attributions in patients with coronary artery disease and classify them according to attribution theory.

DESIGN

Patients with angiographically verified coronary artery disease (n = 459) were asked to report causal attributions by answering the respective open-ended item of the Brief Illness Perception Questionnaire.

MAIN OUTCOME MEASURES

Groups resulting from classifications were characterised with regard to sociodemographic and clinical variables, Quality of Life (SF-12), depression (PHQ-9), anxiety (GAD-7), and illness perception (BIPQ).

RESULTS

Stress emerged as the single most important attribution followed by various behavioural factors and genetic predisposition. There was a remarkable mismatch between the presence of modifiable risk factors (smoking, obesity) and patient-reported illness attributions. Based on the results of the descriptive categorisation of illness attributions we developed a transparent, easily reproducible scheme for dimensional classification of the fifteen most common responses according to attribution theory. The classification resulted in four groups: Behaviour/Emotional State, Past Behaviour/Emotional State, Physical/Psychological Trait and External.

CONCLUSION

We found a pattern of illness attributions largely in line with previous trials. The dimensional classification resulted in four groups and highlighted potential entry points for physician-patient communication aimed at establishing beneficial disease self-management.

Patients' beliefs about the causes of heart disease: relationships with risk factors, sex and socio-economic status

BACKGROUND

Patients' beliefs about the causes of their heart disease (causal attributions) are important to effective medical communication, psychological adaptation, and adherence to advice. We assessed the extent to which causal attributions relate to risk factors, sex and socio-economic status in men and women diagnosed with acute coronary syndrome.

DESIGN

We conducted an interview and questionnaire study of 171 acute coronary syndrome patients assessed within 5 days of admission to three hospitals in the London area.

METHOD

Patients rated beliefs in the role of 16 factors in causing their heart disease. Associations between attributions and risk factors were assessed, and differences in beliefs by sex and socio-economic status (defined by educational attainment) analysed.

RESULTS

The most common attributions were to stress, smoking, high blood pressure, chance or bad luck, and heredity. Attributions were strongly associated with risk factors: 90% of smokers attributed heart disease to smoking, compared with 0% never smokers; 90.4% of hypertensives attributed heart disease to high blood pressure, 72.2% of patients with a positive family history to heredity, 85% of obese patients to being overweight, and 49% of sedentary patients to lack of exercise. Attributions to stress were related both to current mood and reports of recent life stress. There were few sex differences, but higher socio-economic status patients were more likely to attribute heart disease to heredity and genetic factors.

CONCLUSIONS

Causal beliefs about heart disease are strongly associated with risk factors. Effective communication about modifiable risk factors may influence causal beliefs and stimulate lifestyle change, thereby promoting secondary prevention.

Perceptions of cause and control of impulse control behaviours in people with Parkinson's disease

OBJECTIVES

 Impulse control behaviours (ICBs) have been a recent focus of research in people with Parkinson's disease (PD). However, the current literature is largely limited to a biomedical understanding and gaps remain in our understanding of the perceived cause of these behaviours and how people themselves experience them. Consequently, this study sought to investigate how people with PD perceive the cause and controllability of their ICB.

DESIGN

 The study utilized qualitative methodology involving semi-structured interviews. Interpretative phenomenological analysis (IPA) allowed an in-depth exploration of the subjective experience of ICBs.

METHODS

 Ten people with idiopathic PD and current or recent history of ICBs were recruited from an existing research participant pool.

RESULTS

 The themes that arose from the participants' accounts were 'Conflicting views on causality', 'Impulse control behaviours as a coping strategy', and 'The relationship between causal attribution and perceived controllability'.

CONCLUSION

 Participants' beliefs about the cause of ICBs varied from externalized cause (medication) to internalized (coping with the impact of PD). These causal attributions were fundamental to the perceived controllability of the behaviours and psychological benefits. Further research is warranted to explore a psychosocial viewpoint of this feature of PD and to provide appropriate and effective biopsychosocial interventions.

Causal beliefs and behaviour change post-myocardial infarction: How are they related?

INTRODUCTION

Weinman, Petrie, Sharpe, and Walker (2000) showed that the causal attributions of a sample of first-time myocardial infarction (MI) patients and their spouses from Auckland, New Zealand, were associated with changes in health-related behaviour over the first 6 months post-MI. However, their analyses did not control for pre-MI health-related behaviour.

METHOD

This paper reports a re-analyses of the Auckland data, and a replication study conducted with 155 first-time MI patients in Brighton, United Kingdom (UK), to investigate whether baseline attributions for MI were related to health-related behaviour change at 6 months (N=132). Spouses (N=85) also completed the attribution questionnaire at baseline.

RESULTS

There was no consistent relationship between the causal attributions of patients and subsequent behaviour change in Auckland and Brighton. For both samples, causal attributions were associated with pre-MI behaviour.

CONCLUSIONS

The data from both samples suggest that the causal attributions of MI patients and their spouses may be realistic, but not predictive of subsequent changes in behaviour.

Perceptions of exercise among people who have not attended cardiac rehabilitation following myocardial infarction

Perceptions of exercise among nonattenders of cardiac rehabilitation (CR) were explored using semi-structured interviews. Analysis indicated that participants did not recognize the cardiovascular benefits of exercise, and perceived keeping active through daily activities as sufficient for health. Health professionals were perceived to downplay the importance of exercise and CR, and medication was viewed as being more important than exercise for promoting health. The content of CR programmes and the benefits of exercise need to be further explained to patients post-MI, and in a manner that communicates to patients that these programmes are valued by significant others, particularly health professionals.

Idiosyncratic personal explanations for blood glucose events are associated with poorer self-management and glycemic control in adult patients with long-standing type 1 diabetes

OBJECTIVE

To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA(1c) [A1C]), self-management, and adjustment to diabetes.

RESEARCH DESIGN AND METHODS

A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes.

RESULTS

Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by self-management behavior. Participants who made personal and stable attributions appraised their diabetes more negatively.

CONCLUSIONS

Clinicians should be sensitive to patients' causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.