Psychosocial characteristics after acute myocardial infarction: The ENRICHD pilot study

Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill, USA.
Journal of Cardiopulmonary Rehabilitation 01/2001; 21(6):353-62.
Source: PubMed


Psychosocial factors, such as emotional distress and social isolation, have been increasingly recognized as important risk factors for patients' recovery from acute myocardial infarction (AMI). This study examined age, gender, and ethnic differences in depression and general distress, social support, and health-related quality of life after AMI.
Data came from a series of 88 patients aged 62.1 +/- 14.2 years (46% female) who were hospitalized for AMI at eight different US clinical centers participating in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Pilot Study. Standardized psychometric measures were administered to assess three psychosocial domains: (1) depression and general distress (mental health functioning), (2) social support, and (3) health-related quality of life. Multivariate analysis of variance was used to examine the effects of age, gender, and ethnic differences in each of the three psychosocial domains.
Female patients reported higher levels of depression and distress compared with male patients (P = .040). Gender differences in mental health functioning differed by age (P = .046), with the greatest differences observed among younger female patients. Older patients (P = .014) and female patients (P = .025) reported lower levels of social support compared with younger and male patients, respectively. Minority patients did not differ from nonminority patients in mental health functioning or social support, and there were no significant differences in post-AMI quality of life on the basis of age, gender, or ethnicity.
The psychosocial risk profile after AMI may be different for male and female patients, and interventions may need to take account of each gender's specific needs.

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    • "Women with CHD had lower quality of life than women in the healthy group at baseline but no significant differences were found in depressive caseness at any time. Our finding of no gender differences in quality of life at baseline is in agreement with two earlier studies of myocardial infarction patients (Kristofferzon et al., 2005; Mendes de Leon et al., 2001). Our study is the first to show that women's quality of life is better than men's quality of life in the two and four years following a CHD event. "
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    ABSTRACT: The objective of this study is to investigate gender-specific trajectories in well-being among older people with coronary heart disease (CHD) and to compare them with those of healthy people. The study included a sample of 4496 participants from the first three waves of the English Longitudinal Study of Ageing (2002-2003 to 2006-2007). We measured well-being using quality of life (CASP-19; 'control', 'autonomy', 'pleasure' and 'self-realization') and depressive caseness (three or more symptoms on the CESD-8; Centre for Epidemiologic Study Depression scale). After adjustment, at two- and four-years follow-ups, women had three points higher quality of life than men (p < 0.001). When looking at each quality of life's domain we found that women reported higher scores of autonomy compared to men. The gender difference in the probability of having depressive caseness reduced to 7 percentage points at four-year follow-up from 13 percentage points in the previous occasions. Men's quality of life declined progressively over time by 3 points (p < 0.001) (equivalent to the effect of having diabetes) but no changes in prevalence of depressive caseness were found. Women's quality of life only declined after four-year follow-up by less than 2 points (p < 0.001), while in the same period their probability of reporting depressive caseness reduced by 6 percentage points (p < 0.001). Women had better quality of life than men in the two and four years following a CHD event, and were not more likely than men to report depressive caseness in the long term. Men's quality of life deteriorated progressively over time, among women it did not deteriorate in the first two years following a CHD event; women had a long-term improvement in depressive caseness.
    Aging and Mental Health 03/2015; DOI:10.1080/13607863.2015.1020410 · 1.75 Impact Factor
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    • "In addition, non attenders had poorer depression scores than attenders (p < 0ยท01). While previous studies have shown depression to be a known risk factor for patients with cardiac disease (Mendes de Leon et al. 2001, Dobbels et al. 2002, Bjerkeset et al. 2005) and to be more prevalent in older populations, exercise has been shown to improve depression scores, mood and somatisation (Kavanagh et al. 2002). "
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    ABSTRACT: The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Mixed methods. A purposive sample of 31 older men and women (> or =65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0.01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: 'The sensible thing to do', 'Assessing the impact' and 'Nothing to gain'. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person's perspective could help guide more appropriate intervention strategies.
    Journal of Clinical Nursing 07/2009; 18(13):1878-88. DOI:10.1111/j.1365-2702.2009.02798.x · 1.26 Impact Factor
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    • "Regular participation in physical activity is associated with protection against CVD, and improvements in physical and psychological health (Miller et al. 1997, Wenger et al. 1999, Thompson et al. 2003). Negative psychosocial factors such as major depression, social isolation, or chronic stress can adversely affect pathophysiological mechanisms associated with CVD, and also contribute to poor health behaviour (Rozanski et al. 1999, Ziegelstein et al. 2000, Mendes de Leon et al. 2001, Astin et al. 2003, Rosengren et al. 2004). Thoughts, feelings and personal exercise behaviour can affect health outcomes and psychological well-being (Baum & Posluszny 1999). "
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    ABSTRACT: This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America. Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors. This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy. A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12). Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.
    Journal of Advanced Nursing 05/2006; 54(3):313-29. DOI:10.1111/j.1365-2648.2006.03809.x · 1.74 Impact Factor
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