Ruud A.M. Erdman

Type D personality is associated with increased anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator and their partners

Objective: We investigated the prevalence of anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator (ICD) and their partners, and the role of personality factors and social support as determinants of distress. Methods: Of all surviving patients (n = 221) having had an ICD implanted between October 1998 and January 2003, 182 patients and 144 partners completed the Hospital Anxiety and Depression Scale, the Type D Personality Scale, and the Perceived Social Support Scale. Type D personality defines those who tend to experience increased negative distress and who do not express these negative emotions in social interactions. Clinical variables for the patients were obtained from medical records. Results: Thirty-one percent of patients versus 42% of partners suffered from symptoms of anxiety (p = .048); symptoms of anxiety were particularly prevalent in male partners. Twenty-eight vs. 29% suffered from depressive symptoms (p = .901). In patients, Type D personality was independently related to anxiety (OR: 7.03; 95% CI: 2.32–21.32) and depressive symptoms (OR: 7.40; 95% CI: 2.49–21.94) adjusting for all other variables. Underlying cardiac disease pathology did not explain differences in patient distress. In partners, Type D personality was independently associated with increased symptoms of anxiety (OR: 8.77; 95% CI: 3.19–24.14) and depression (OR: 4.40; 95% CI: 1.76–11.01). Conclusion: Partners experienced similar levels of depression but higher levels of anxiety compared with ICD patients. Personality was an important explanatory factor of distress in both ICD patients and their partners. Research is now warranted to investigate the implications of this finding for the clinical course of ICD patients, as Type D personality has been associated with adverse prognosis in patients with coronary artery disease. CAD = coronary artery disease; ICD = implantable cardioverter defibrillator; MI = myocardial infarction.

PREDICTION OF QUALITY OF LIFE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY :A REVIEW AND EVALUATION OF MULTIPLE, RECENT STUDIES

Objective To review studies predicting psychosocial outcome after coronary artery bypass graft surgery (CABG). Methods: Seventeen prospective studies, appearing in the MEDLINE and PsycLIT data bases between 1986 and 1996, were reviewed regarding objectives, methodological issues, results, and clinical relevance. Results: All studies reported that psychological factors had predictive value. In particular, preoperative anxiety and depression predicted postoperative psychological maladjustment; social support, preoperative feelings of control, denial, and optimism contributed to psychological adjustment. Conclusions: Many specific psychological outcomes seem to be best predicted by preoperative assessment of functions in that specific area, especially in the case of anxiety and depression. Furthermore, personality factors including denial, optimism, control, and the need for support appear to be predictors of psychological outcome. Appropriate identification of predictive factors might improve the development of individually tailored interventions for patients at risk of postoperative psychological problems.

Effect of exercise training on quality of life in patients with chronic heart failure

The effect of exercise training on quality of life and exercise capacity was studied in 67 patients with mild to moderate chronic heart failure (CHF; age: 65.6+/-8.3 years; left ventricular ejection fraction: 26.5+/-9.6%). Patients were randomly allocated to either a training group or to a control group. After intervention a significantly larger decrease in Feelings of Being Disabled (a subscale of the Heart Patients Psychological Questionnaire) and a significantly larger increase in the Self-Assessment of General Well-Being (SAGWB) were observed in the training group. Exercise time and anaerobic threshold were increased in the training group only. The increase in exercise time was related to both Feelings of Being Disabled and SAGWB. We conclude that supervised exercise training improves both quality of life and exercise capacity and can be safely performed by chronic heart failure patients.

International development of the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD)

Objective: The international development of the Parents’ Index of Quality of Life in Atopic Dermatitis (PIQoL-AD), a quality of life (QoL) instrument specific to parents of children with atopic dermatitis (AD) is described. Method: The instrument was developed simultaneously in several countries. Its content was derived from 65 qualitative interviews with parents in the UK, Netherlands and Italy. The measure was then produced for the UK, Netherlands, Italy, Germany, France, US and Spain. Field-test interviews were conducted with approximately 20 patients in each country to assess face and content validity. A two time-point survey was conducted with between 45 and 328 parents in each country to finalise the instrument through application of the Rasch model and to evaluate the psychometric properties of the final instrument. Results: Application of the Rasch model to the survey data identified the final 28-item version. All language versions had good item fit, test–retest reliability (above 0.85), internal consistency and promising validity. Conclusions: The PIQoL-AD is a valuable instrument for inclusion in clinical trials and routine clinical practice. It provides distinct and complementary information to that of existing dermatology-specific measures and has been shown to be responsive to changes in QoL in clinical trials.

Effects of treating exhaustion in angioplasty patients on new coronary events : Results of the randomized exhaustion intervention trial (EXIT)

Background: Extreme fatigue is a common complaint in percutaneous coronary intervention (PCI) patients, and is associated with an increased risk for new cardiac events. The objective of the Exhaustion Intervention Trial (EXIT) was to determine whether a behavioral intervention on exhaustion reduces the risk of a new coronary event after PCI. Methods and Results: Seven hundred ten consecutive patients, ages 35 to 68 years, who felt exhausted after PCI were randomized into an intervention group and a usual-care group. The intervention was based on group therapy focusing on stressors leading to exhaustion, and on support for recovery by promoting rest and making rest more efficient. One month after PCI, 50% of the patients felt exhausted. The intervention reduced the odds of remaining exhausted at 18 months by 56% in those without a previous history of coronary artery disease (CAD) (OR = 0.44; 95% CI 0.29–0.66), but had no effect on exhaustion in those with a history of CAD (OR = 0.93; 95% CI 0.56–1.55; p = .78). The intervention did not reduce the risk of a new coronary event within 2 years (RR = 1.14; 95%CI 0.82–1.57). Post-hoc analyses suggest that the effect of the intervention was limited by a positive history of CAD, the presence of a chronic, painful condition (especially rheumatism), and by opposite effects on early and late cardiac events. Conclusion: A behavioral intervention in PCI patients has a beneficial effect on feelings of exhaustion. It could not be demonstrated that the intervention reduces the risk of a new coronary event within 2 years. PCI = percutaneous coronary intervention; CAD = coronary artery disease; MQ = Maastricht Questionnaire; MIVE = Maastricht Interview Vital Exhaustion; EXIT = Exhaustion Intervention Trial; CABG = coronary artery bypass graft; MI = myocardial infarction.

Pre-implantation implantable cardioverter defibrillator concerns and Type D personality increase the risk of mortality in patients with an implantable cardioverter defibrillator

AIMS Little is known about the influence of psychological factors on prognosis in implantable cardioverter defibrillator (ICD) patients. We examined the influence of the distressed personality (Type D) and pre-implantation device concerns on short-term mortality in ICD patients. METHODS AND RESULTS Consecutively implanted ICD patients (N = 371; 79.5% men) completed the Type D Scale and the ICD Patient Concerns questionnaire prior to implantation and were followed up for short-term mortality. The prevalence of Type D was 22.4%, whereas 34.2% had high levels of ICD concerns. The incidence of mortality was higher in Type D vs. non-Type D patients [13.3% vs. 4.92%; hazard ratio (HR): 2.74; 95% confidence interval (CI): 1.24-6.03] and in patients with high vs. low levels of ICD concerns (11.0% vs. 4.5%; HR: 2.38; 95% CI: 1.08-5.23). Type D personality (HR: 2.79; 95% CI: 1.25-6.21) and high levels of ICD concerns (HR: 2.38; 95% CI: 1.06-5.34) remained independent predictors of mortality in separate analyses, adjusting for sex, age, ICD indication, coronary artery disease, and shocks. Patients with clustering of both Type D personality and high levels of pre-implantation concerns (HR: 3.86; 95% CI: 1.64-9.10) had a poorer survival compared with patients with one or none of these risk markers in adjusted analysis. Shocks during the follow-up period were also associated with mortality (HR: 3.09; 95% CI: 1.36-7.04). CONCLUSION Patients with a distressed personality and high levels of pre-implantation device-related concerns had a poorer prognosis, independent of other risk markers including shocks. This subgroup of patients should be identified in clinical practice and would likely benefit from a combined distress management programme and cardiac rehabilitation.

Risk of chronic anxiety in implantable defibrillator patients: A multi-center study

BACKGROUND Little is known about the prevalence of chronic anxiety in patients with an implantable cardioverter defibrillator (ICD). In a multi-center, prospective study, we examined 1) the prevalence of chronic anxiety (i.e., patients anxious at implantation and 12 months), and 2) predictors of chronic anxiety. METHODS ICD patients (N=284; 21.1% women) anxious (cut-off ≥ 40 on the State Trait Anxiety Inventory (STAI)) at the time of implantation qualified for inclusion in the current study. Patients completed the Type D Scale at baseline and the STAI (state measure) at baseline and 12 months. RESULTS Of 284 patients anxious at baseline, 53.9% (153/284) remained anxious at 12-month follow-up. Diabetes (OR:2.49; 95%CI:1.16-5.36), cardiac resynchronization therapy (CRT) (OR:2.03; 95%CI:1.02-4.05), and Type D personality (OR:1.87; 95%CI:1.09-3.19) were independent predictors of 12-month anxiety, adjusting for demographic and clinical variables including ICD therapy during follow-up. Shocks (both appropriate and inappropriate during follow-up) were not associated with chronic anxiety at 12 months (OR:0.94; 95%CI:0.42-2.12). The prevalence of chronic anxiety in the 96 patients with no risk factors was 34.4% and 63.8% in the 120 patients with either diabetes, CRT, or Type D personality. CONCLUSIONS More than 50% of ICD patients anxious at the time of implantation were still anxious at 12 months, indicating a high level of chronicity. Diabetes, CRT, and Type D personality were independent predictors of chronic anxiety. ICD patients anxious at implantation should be closely monitored and offered adjunctive psychosocial intervention if symptoms do not remit spontaneously in order to prevent adverse health outcomes.

The course of anxiety and depression in patients undergoing coronary artery bypass graft surgery

A semilongitudinal study was designed to follow-up the course of anxiety and depression in patients undergoing coronary artery bypass graft (CABG) surgery. The focus was on possible effects of gender and age on variations in both mean level and interindividual differences over time. At two timepoints before and two after surgery, 217 patients completed self-report questionnaires. Multivariate testing revealed an overall decrease in mean levels of anxiety and depression in the postoperative period but different trends for men and women. Compared with men, women reported more anxiety and depression, both pre- and postoperatively, but showed a relatively stronger decrease in the early postoperative period. Regarding variations in interindividual differences over time, multivariate testing revealed different trends of depression for men and women. Women appeared to be most homogeneous in the early days after surgery, whereas interindividual differences for men showed a stable trend.

Encouraging Psychological Outcomes After Altruistic Donation to a Stranger

In a growing number of transplant centers worldwide, altruistic donors are accepted to anonymously donate a kidney to a stranger. An important hesitation to expand these transplantation programs is the fear of evoking psychological distress in the altruistic donor after donation. To what extent this fear is justified has not yet been systematically investigated. In this study, 24 altruistic donors were interviewed on average 2 years after donation. Lifetime mental health history, current psychological complaints, satisfaction with and impact of the donation on well‐being, motives for donation, communication with recipient and donation experience were assessed. Altruistic donors report a considerable positive impact of donation on psychological well‐being, whereas negative impact was limited. Satisfaction with donation was very high. Although a history of a psychiatric diagnosis was ascertained in almost half of the donors, psychological complaints before and after donation were comparable to national average norm scores. Motives for donation were genuine and the experience of donation generally conformed to their expectations. In conclusion, living kidney donation to a stranger does not appear to exacerbate psychological complaints. Moreover, altruistic donors report considerable satisfaction and personal benefit. The exceptional gift of altruistic donors can contribute toward solving the current organ shortage issue.

Clustering of device-related concerns and type D personality predicts increased distress in ICD patients independent of shocks

Background: This study examined the impact of clustering of device‐related concerns and Type D personality on anxiety and depressive symptoms during a six‐month period and the clinical relevance of shocks, implantable cardioverter defibrillator (ICD) concerns, and Type D.