Thérèse van Elderen

Coping with coronary heart disease : A longitudinal study

This longitudinal study evaluated the effects of two types of coping strategies, approach and avoidance, on anxiety, depression, and well-being in patients with coronary heart disease. Measurements were made at three timepoints: 1 month, 3 months, and 12 months after the cardiac event. Both cross-sectional and longitudinal relations were explored. At all three measurement points significant negative cross-sectional relations were found between approach and well-being, and significant positive cross-sectional relations were found between approach, on the one hand, and anxiety and depression, on the other. At the first measurement point, avoidance showed a positive association with well-being, and a negative association with anxiety. Longitudinal analyses, however, revealed a negative relationship between approach at the first measurement points and anxiety and depression at later measurement points. Likewise, there was a positive association between approach at the first two measurement points and well-being at later measurement points. The results of this study demonstrate the importance of facing and working through the trauma of the coronary event. Although unfavorable in the short term, working through the trauma can attenuate long-term emotional distress. These results suggest that assessment of the psychological consequences of coronary heart disease and development of interventions should not be based only on cross-sectional data, but should take into account longitudinal relations between coping and psychosocial outcome measures.

Quality of life after myocardial infarction: Translation and validation of the MacNew Questionnaire for a Dutch population

A wide range of instruments have been used in health-related quality of life (HRQL) assessment of patients with coronary artery disease. The MacNew heart disease health-related quality of life questionnaire (MacNew) is a disease-specific measure of HRQL, that has been found to have both good discriminative and evaluative properties. The objective of the present study was to translate the MacNew for a Dutch population, and assess its reliability and validity. Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac event, participated in the study. Questionnaires were filled out at baseline, at 3 months, and at 12 months. A clinically relevant three-factor solution, reflecting an emotional, physical, and social domain of HRQL, allowed us to explain 55% of variance. Angina pectoris was consistently found to be significantly associated with worse HRQL. The pattern of correlations between the subscales of the MacNew on the one hand, and between the subscales of the MacNew and two other, related questionnaires on the other hand, indicated only modest convergent and discriminant validity. The internal consistency was found to be fair to (very) good (ranging between 0.78 and 0.95). Finally, the Dutch MacNew was demonstrated to be substantially more responsive than two other instruments measuring physical and psychological well-being.

The impact of angina and cardiac history on health-related quality of life and depression in coronary heart disease patients

Objective: To prospectively examine the contribution of angina and cardiac history to health-related quality of life (HRQoL) and depression in cardiac patients, over 6 months post-hospitalization. Methods: Participants were myocardial infarction (MI), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) outpatients under the age of 70 years. One hundred and seventy-one patients consented to participate, with 121 patients being retained 6 months later (71% response rate). The impact of the patients cardiac history and the presence of angina on physical, social and emotional HRQoL and depression was examined. Results: At baseline, cardiac history was not significantly related to any of the dimensions of HRQoL or depression. At 6-month follow-up, cardiac history significantly predicted a higher level of depression, and angina was predictive of a significantly worse emotional, physical and social HRQoL and a higher level of depression. Discussion: The presence of a cardiac history is associated with depression 6 months post-cardiac event, and angina is associated with both an adverse HRQoL and higher levels of depression. As past research has demonstrated that depression is a risk factor for mortality in patients with established heart disease, it is important from both a clinical and a research perspective to address these issues.

Goal disturbance predicts health-related quality of life and depression 4 months after myocardial infarction

OBJECTIVES The aim of this longitudinal study was to determine whether the event of a myocardial infarction (MI) would lead to a disturbance in important higher-order goals, and whether goal disturbance could predict health-related quality of life (HRQL) and depression 4 months later, in addition to baseline scores, demographic characteristics, presence of anginal complaints (AP) or chest pain, coping strategies and social support. METHOD A total of 113 MI patients completed questionnaires shortly after hospitalization (T1) and 4 months later (T2), assessing (an impact of the event on) important higher-order goals (T1), disease-related coping strategies (T1), perceived adequacy of social support (T2), AP (T2), HRQL, and depression (T2). Two separate hierarchical regression analyses were performed with HRQL and depression at T2 as dependent variables. RESULTS The results suggest that the experience of an MI has an impact on the attainment of higher-order goals. Goal disturbance is an independent predictor of both HRQL and depression after MI. CONCLUSION A goal theory perspective can provide additional insights into HRQL outcomes after an MI.

How goal disturbance, coping and chest pain relate to quality of life: A study among patients waiting for PTCA.

This article describes psychological correlates of quality of life (QOL) in patients on a waiting list for percutaneous transluminal coronary angioplasty (PTCA). Variables were selected based on a theoretical model describing psychological correlates of QOL in PTCA patients. This model was based on self-regulation and stress-coping theories. The variables in the model are stress appraisal, coping, coping resources, and general and disease-specific QOL variables. Respondents were 122 patients on a 3-month waiting list for a PTCA. Results indicated that PTCA patients had a poorer QOL than matched healthy controls. Using a path analysis approach to regression analysis, it appeared that goal disturbance, avoidant coping, approach coping, and chest pain were related to QOL. More specifically, chest pain and goal disturbance were only related to health-related QOL and negative affect. Both approach and avoidant coping were related to QOL variables. Results could be explained adequately using self-regulation theory. Recommendations for future research and for form and content of rehabilitation programmes were made.

Modeling predictors of quality of life after coronary angioplasty.

Psychological predictors of quality of life in patients undergoing coronary angioplasty were investigated using a prospective model based on self-regulation and stress-coping theories. Predictors (chest pain, disturbance of personal goals, stress perception, approach coping, avoidant coping, and optimism) and three quality of life indicators (disease-specific quality of life, positive affect, and negative affect) were measured with questionnaires in 158 patients both when they were admitted on the waiting list for angioplasty and 3 months after angioplasty. The results were congruent with expectations based on the theories and indicated that the models predicting disease-specific quality of life and negative affect fit the data well. Avoidant Coping and Stress Perception predicted all quality of life indicators. Goal Disturbance predicted only negative quality of life variables, and Approach Coping predicted only positive quality of life variables. Chest Pain predicted Disease-Specific Quality of Life and Positive Affect. Optimism served as a coping resource. Individualized behavior modification interventions were recommended, but the data suggest that patients may not be easily persuaded to engage in health behavior.

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training. The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident. In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation. These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.

Psychometric characteristics of the Self-Expression and Control Scale in a sample of recurrent suicide attempters

Abstract The Self-Expression and Control Scale (SECS), constructed to investigate the role of anger expression and anger control in somatic and mental diseases, was administered to patients with recurrent suicide attempts. The psychometric properties of the SECS proved to be highly acceptable and comparable with the psychometric properties of the instrument administered to a community sample. Suicide attempters scored higher on trait anger, higher on the internalization of anger and lower on both control of the internalization and the externalization of anger than controls in a community sample. Additionally, suicide attempters with a diagnosis of borderline personality disorder scored higher on the externalization of anger, and lower on both control of the internalization and the externalization of anger than suicide attempters without this diagnosis. Finally, the subgroup of patients with a psychiatric diagnosis of a“recurrent deliberate self-harm” scored higher on the internalization of anger than other patients with recurrent suicide attempts. These results show that the SECS is able to make a distinction between several subgroups of suicide attempters, and between suicide attempters and persons in a community sample with respect to the expression and control of anger. As such, the SECS can give indication for optimal psychotherapeutic treatment.

Examining a Model of Stress Reactions of Bank Directors

The purpose of this study was to investigate to what level work-related and environmental/personality characteristics explain individual differences in psychological and physical well-being, and absenteeism. The Michigan model, as developed by the Institute for Social Research at the University of Michigan, was used as a base for further analyses. A number of 376 bank directors was included in the study. Using the LISREL program for testing causal assumptions, a model resulted that explained substantial amounts of variance for psychological and physical well-being. The model, however, was not effective to explain absenteeism.

Goal disturbance, coping, and psychological distress in partners of myocardial infarction patients: Taking account of the dyad

Abstract This study aims to explore the relationship between goal disturbance and levels of psychological distress in partners of myocardial infarction (MI) patients. Furthermore, the role of partner and patient coping behaviour in the context of goal disturbance is explored. Forty dyads were interviewed and completed questionnaires 1 month (T1) and 4 months (T2) post MI. All patients were men. Patients and partners do not differ on anxiety or depression scores, however, patients experience significantly more higher order goal disturbance at T1. Partners reporting more goal disturbance also show increased distress at T1. More use of approach coping by partners contributes to explained variance in their goal disturbance. Partner avoidant coping is moderated by patient avoidant coping. Approaches to reduce distress in partners should thus take account of goal disturbance and coping behaviours within the dyad.