Piroska Balog

Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study.

Objective: To explore the long-term effect of anxiety and depression on outcome after cardiac surgery. To date, the relationship between psychosocial factors and future cardiac events has been investigated mainly in population-based studies, in patients after cardiac catheterization or myocardial infarction. Methods: In total, 180 patients who underwent cardiac surgery using cardiopulmonary bypass were prospectively studied and followed up for 4 years. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI), living alone, and education level along with clinical risk factors and perioperative characteristics were assessed. Psychological self-report questionnaires were completed preoperatively and 6, 12, 24, 36, and 48 months after discharge. Clinical end-points were mortality and cardiac events requiring hospitalization during follow-up. Results: Average preoperative STAI-T score was 44.6 ± 10. Kaplan-Meier analysis showed a significant effect of preoperative STAI-T >45 points (p = .008) on mortality. In multivariate models, postoperative congestive heart failure (OR: 10.8; 95% confidence interval [CI]:2.9–40.1; p = .009) and preoperative STAI-T (score OR: 1.07; 95% CI: 1.01–1.15; p = .05) were independently associated with mortality. The occurrence of cardiovascular hospitalization was independently associated with postoperative intensive care unit days (OR: 1.41; 95% CI: 1.01–1.96; p = .045) and post discharge 6th month STAI-T (OR: 1.06; 95% CI:1.01–1.13; p = .03). Conclusions: The results of the present study suggest that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and identification of patients at risk of mortality and cardiovascular morbidity after cardiac surgery. BDI = Beck Depression Inventory; STAI-S = state anxiety subscale; STAI-T = trait anxiety subscale of Spielberger State-Trait Anxiety Inventory; CPB = cardiopulmonary bypass; CABG = coronary artery bypass grafting; CHF = congestive heart failure; CHD = coronary heart disease; ICU = intensive care unit; MI = myocardial infarction; PTSD = posttraumatic stress disorder.

Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Coronary Risk Study

OBJECTIVE The aim of this study was to investigate the effect of marital and job stress on depressive symptoms in middle aged women with coronary heart disease (CHD) and healthy women who were cohabiting and currently working. METHOD Data were obtained from the Stockholm Female Coronary Risk (FemCorRisk) Study, a population-based case-control study, comprising all women aged 65 years or younger who were admitted for an acute event of CHD between 1991 and 1994. For each patient, an age-matched healthy control was recruited. Marital stress was assessed by a structured interview developed in our research laboratory and work stress by the Karasek demand-control questionnaire. Depressive symptoms were measured by a questionnaire derived from Pearlin et al. [J. Health Soc. Behav. 22 (1981) 337], which was validated by the Beck Depression Inventory. RESULTS Depressive symptoms were twice as common in women with as in women without coronary disease: Marital stress was statistically significantly associated with depressive symptoms, even after controlling for age, educational level, menopausal status, body mass index (BMI), sedentary lifestyle, cigarette smoking and severity of heart failure symptoms. In both groups, depressive symptoms increased with increasing exposure to marital stress in a graded fashion. Work stress was not associated with depressive symptoms after multivariate adjustment. CONCLUSIONS Marital stress but not work stress is independently related to depressive symptoms in women. Women with coronary disease react similarly to marital stress as healthy women, but depart from a higher level of depression, which may be explained by their poorer health status.

Measures of stress in epidemiological research

A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individuals coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individuals illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

social relations in women with coronary heart disease: the effects of work and marital stress

Background Studies have previously shown that psychosocial stress, related to both work and family, is associated with the increased risk of coronary heart disease (CHD) morbidity and mortality. The objective of this study was to examine how social relations are affected by marital stress and work stress in a population-based sample of Swedish women with CHD. Method Data was obtained from the Stockholm Female Coronary Risk Study, comprising 292 women aged 65 years or younger, with a mean age of 56 (SD = 7) years admitted for an acute event of CHD and examined 3-6 months after hospitalization. Marital and work stress was assessed using the Stockholm Marital Stress Scale and the Swedish version of the Karasek demand-control questionnaire, respectively. Condensed versions of the Interview Schedule for Social Interaction (ISSI) and of Interpersonal Support Evaluation List (ISEL) were used to assess social relations and social support. Results Marital stress was associated with less social integration (P<0.001), less appraisal support (P<0.001), a lower sense of belonging (P<0.01) and less tangible support (P<0.01) even after controlling for work stress. Adjustment for age, socioeconomic status (education and occupational status) did not alter these results significantly. Work stress did not show statistically significant effects on any of the measured social relations. Conclusion The present study showed that marital stress influenced womens social relations. These results suggest that marital stress needs to be further investigated not only as an independent but also as an interactive risk factor for women with CHD. J Cardiovasc Risk 10:201–206

The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery.

BackgroundPsychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.MethodsAfter informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.ResultsDuring a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.ConclusionsOur results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.

Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery

Our aim was to prospectively examine the association of psychosocial factors with adverse outcome after cardiac surgery. One hundred and eighty cardiac surgery patients were enrolled and contacted annually by mail. Depression [Beck depression inventory (BDI)], anxiety [state anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-S) and trait anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-T)] were investigated annually, social support, negative affectivity, social inhibition (SI), illness intrusiveness, self-rated health and sleeping disorders were investigated by standardized tests at the second and fifth year. The end-point was the major adverse cardiac and cerebrovascular event (MACCE) including death. Twenty-eight (15.5%) patients died by the end of the fifth year. At the end of the second and fifth years, 146 (81.1%) and 118 (65.5%) patients fulfilled the tests, respectively. At the end of the second year after adjustment for medical and perioperative factors worse self-rated health [adjusted hazard ratio (AHR): 0.67, P=0.006], sleeping disorders (AHR: 1.14, P=0.001), higher illness intrusiveness (AHR: 1.03, P=0.018), higher BDI (AHR: 1.12, P=0.001), STAI-S (AHR: 1.09, P=0.001) and higher STAI-T scores (AHR: 1.08, P=0.002) showed higher risk for MACCE. Significant individual elevation in scores of sleeping disorders, illness intrusiveness and SI were observed over the three-year period in the MACCE group. Assessment of psychosocial factors could help in identifying patients at high-risk for MACCE after cardiac surgery.

A bifactor model of the Posttraumatic Growth Inventory

Purpose: The Posttraumatic Growth Inventory (PTGI) is a self-administered measurement instrument designed to provide information concerning positive psychological changes after a traumatic life event. The aim of the present study was to examine the psychometric properties of the PTGI in a Hungarian sample. By examining a bifactor model of the instrument, we also wanted to contribute to the establishment of an evidence-based practice concerning the use of different score types (total score versus subscale scores). Methods: Altogether, 691 Hungarian respondents (82.2% female; Mage = 33.0 ± 13.4 years), who experienced some kind of trauma or loss, participated in this study. Results: A series of confirmatory factor analyses revealed that among the tested first- and second-order models, a bifactor model provided the best-fit to our data (χ2/df = 4.32, Comparative Fit Index = .91, root mean square error of approximation = .07, standardized root mean square residual = .04). Further, the Hungarian version of the PTGI showed high internal consistency (Cronbachs alpha = .93, omega total = .95, omega hierarchical = .87) and test–retest reliability (r = .90; p < .01) coefficients. However, omega hierarchical coefficients (.14–.40) and explained variance values (.05–.10) for the subscales were low. Conclusions: The present study provided empirical support for the psychometric adequacy of the Hungarian adaptation of the PTGI and suggests that only the total and not the subscale scores of the inventory should be used.

Vital exhaustion and anxiety are related to subjective quality of life in patients with acute myocardial infarct before cardiac rehabilitation

AIMS AND OBJECTIVES To examine psychological risk factors and somatic factors in patients after myocardial infarction. To study the relationship between somatic and psychological factors, their influence on subjective quality of life (well-being) and also to examine possible gender differences. BACKGROUND There has been a growing body of evidence that psychosocial factors are risk factors for incident and recurrent myocardial infarction. DESIGN Descriptive correlational and cross-sectional survey design. METHODS In patients (n = 97, 67 men), the level of depression and anxiety, vital exhaustion, sleep disturbances and well-being were assessed. Left ventricular ejection fraction, left ventricular diastolic diameter, body mass index, metabolic equivalents and the number of diseased vessels were retrieved from medical records. RESULTS Anxiety, vital exhaustion and sleep disturbances were significantly higher in women than in men. Well-being showed a significant linear correlation with body mass index, anxiety, depression, vital exhaustion and sleep disturbances scores. After adjustment for psychological risk factors and somatic parameters, only vital exhaustion and anxiety correlated significantly with well-being. However, there were gender differences in predictive variables of well-being. Anxiety in men and vital exhaustion in women showed a linear correlation with the subjective quality of life. CONCLUSION Our study revealed that only vital exhaustion and anxiety showed a significant correlation with well-being in patients. RELEVANCE TO CLINICAL PRACTICE During cardiac rehabilitation, it is important to detect and treat not only depression but also vital exhaustion and anxiety, because by reducing these psychological conditions, we can improve well-being.

[Relationships between psychological well-being, lifestyle factors and fertility].

INTRODUCTION 10 to 15% of the Hungarian fertile age population struggles with reproductivity problems. Previous researches have shown that psychological well-being and lifestyle factors play a pivotal role in overall health status, which is closely related to fertility. AIM The aim of the study was to examine fertility-related psychological and lifestyle factors in a Hungarian sample. METHOD 194 women (115 infertile and 79 fertile) took part in the study. Standardized, validated questionnaires were used for the assessment of psychological factors and self-administered questions were used for exploring lifestyle factors. RESULTS The results show that infertile women are younger (33.98±4.89 vs. 36.43±5.81 years, p<0.005) and their psychological status is significantly worse compared to their fertile counterparts. The number of their depressive (BDI 14.00±12.21 vs. 7.79±9.17, p<0.005) and anxiety symptoms is higher (STAI-T 48.53±10.56 vs. 40.25±10.65, p<0.005) compared to fertile women. Findings related to lifestyle factors show that lower level of fluid consumption (1.71±0.67 vs. 1.95±0.68, p<0.05) and diet (31.30% vs. 18.42%, p<0.05) is significantly related to infertility. In this sample higher level of fluid consumption was associated with the fertile group (OR = 1.65, CI = 2.58-1.06), independently of body mass index and age. CONCLUSIONS The results confirm the findings of international researches showing that women struggling with infertility are in worse psychological condition than their fertile counterparts. The authors conclude that the findings demand further investigations and follow-up studies in order to more specifically determine the relationship between fluid consumption and fertility.

Are Vital Exhaustion and Depression Independent Risk Factors for Cardiovascular Disease Morbidity

Objective: The aim of this study was to examine the concurrent effects of vital exhaustion and depression on the development of cardiovascular disease (CVD) morbidity. Method: The sample of this representative, 4-year longitudinal study comprised 2,725 participants (43.56% male, Mage = 58.39 years, SDage = 14.39 years). Individuals being treated for hypertension (n = 277) and cardio- and/or cerebrovascular incidents (n = 131) for the first time during the follow-up period were compared with participants never treated for CVD (n = 2,317). Joint principal component analysis was conducted on the items of the vital exhaustion (shortened Maastricht Questionnaire) and depression (shortened Beck Depression Inventory) measures simultaneously resulting in 3 components representing depression, vital exhaustion, and sleep difficulties. The role of these 3 components in predicting the incidence of CVD morbidity was examined using logistic regression—controlling for traditional risk factors such as sex, age, education, body mass index, smoking, alcohol use, and physical inactivity. Results: In the multivariate analyses, vital exhaustion (OR = 1.20, CI = 1.03–1.39, p = .021) and sleep-related problem (OR = 1.16, CI = 1.00–1.33, p = .044) scores proved to be independent predictors of treatment initiation for hypertension, while sleep-related difficulties predicted CVD event incidence (OR = 1.27, CI = 1.06–1.52, p = .009). However, depressive symptomatology factor scores were not associated with either cardiovascular outcome in the regression analyses. Conclusions: Vital exhaustion and depressive symptomatology showed a different pattern in their relationship with CVD incidence, with vital exhaustion being the more robust predictor. These results suggest that the 2 constructs are not identical and that vital exhaustion deserves consideration when planning and implementing interventions to reduce CVD risk.