Coping predicts depression and disability in heart transplant candidates.

Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7205, USA.
Journal of Psychosomatic Research (Impact Factor: 2.84). 11/2005; 59(4):215-22. DOI: 10.1016/j.jpsychores.2005.06.055
Source: PubMed

ABSTRACT The aim of this study was to describe the coping strategies used by cardiac patients who are pursuing heart transplant and to determine which coping strategies are related to depression and self-reported disability.
This is a cross-sectional design with 50 cardiac patients (74% male) who were inpatients being evaluated for heart transplant at a large medical center. Coping styles were measured using the COPE Inventory (Carver CS, Scheier MF, Weintraub, JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56:267-83). Depression was assessed with the Structured Interview Guide for the Hamilton Depression Rating Scale (HAM-SIGH-D; Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62), and disability was assessed using the Sickness Impact Profile (SIP; Bergner M, Bobbitt R, Carter W, Gilson B. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;19:787-805).
Patients reported using a variety of adaptive coping strategies, but depression and disability were only significantly correlated with maladaptive coping strategies. Multiple regressions demonstrated that denial had the strongest association with depression, and focusing on and venting emotions had the strongest association with disability.
Maladaptive coping styles, such as denial and focusing and venting of emotions, can serve as markers of emotional distress and disability that may identify patients who may benefit from psychologic and psychiatric interventions.

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    ABSTRACT: 1 Özet Bu yaz›da anlat›lmak istenilen; bir hastal›k deil fakat, insan yap›- s›n›n önemli ve s›k rastlan›lan bir özellii olarak hem hekim hem de hastalar› kapsayan somatizasyon (bedensellefltirme) gerçeidir. Beden ve zihin aras›ndaki iliflkinin, teorik ve pratik yönelimlerle tar- t›fl›la gelmesi günümüzün psikosomatik biliminin kurulmas›na ze- min haz›rlam›flt›r. Kar›n ar›s›, haz›ms›zl›k, gö¤üs ar›s›, bafl dön- mesi ve eklem ar›s› gibi s›k rastlan›lan bedensel belirtiler kiflileri bir sal›k kurumuna baflvurmaya yönlendiren en büyük nedenler- dir. Bu, ülkemizde çounlukla gözden kaçan bir konu olsa da, bu belirtilerin geliflimi ve süreklilii hakk›nda yap›lan araflt›rmalar; bi- liflsel-alg›sal, davran›flsal ve psikobiyolojik bileflenlerden oluflan k›- s›r bir döngü oluflturduklar›n› vurgulamaktad›r. Özellikle birinci ba- samak sal›k kurumlar›nda deerlendirilen depresif hastalar, bafl- lang›çta yaln›zca bedensel yak›nmalar›n› aktarabilmektedir. Birinci basamak sal›k kurumlar›nda, bedensel belirtilerdeki hafiflemenin depresyonun sona erifli aç›s›ndan önemli ölçüde tahmin deeri ta- fl›d›¤› hipotezi savunulmaktad›r. Ayr›ca psikososyal faktörlerin bu belirtilerin kronikleflmesinde önemli bir etken olduu da vurgulan- maktad›r. Somatizasyonu farkl› etnik gruplar üzerinde inceleyen baz› çal›flmalar, somatizasyonun dou ülkelerinde bat›dan daha youn gözlendiini belirtmifllerdir. Bu farkl›l›¤›n oluflmas›nda hem hastalar›n kültürel özelliklerinin, hem de hekim ve birinci basamak sal›k kurumlar›n›n farkl› yap›lar›n›n rolü olduu ileri sürülmüfltür. Bu kurumlarda çal›flan hekimlerin çok yönlü klinik deerlendirme becerilerinin gelifltirilmesinin, bu karmafl›k problemin çözümüne büyük yarar salad›¤› gösterilmifltir. Summary Somatisation is not a disease, but a common and important human mechanism involving both doctors and patients. The discussion of the relationship between mind and body, with the theories and practical applications has formed the foundation of today's psychosomatic medicine. Common physical symp- toms such as abdominal pain, irritability, chest pain, dizziness and joint pain the are main reasons of attending a health care center. Sometimes unnoticed in our country, studies about the development and maintenance of these symptoms emphasize a vicious circle with cognitive-perceptual, behavioral, and psy- chobiological components. Patients with depression, particular- ly those seen by primary care physicians, may firstly report somatic symptoms. It is hypothesized that somatic symptom alleviation is a significant predictor of overall outcome in depressed primary care patients. It also emphasized that psy- chosocial factors have an important influence on the chronic evolution of these symptoms. Some of the studies that investi- gated the somatisation through different ethnic groups have suggested that somatisation is seen more densely in Eastern countries rather than West. It is also suggested that this varia- tion may reflect characteristics of physicians and health care systems, as well as cultural differences among patients. Developing the multidimensional clinical reasoning capacity of physicians of the primary care clinics can help solve this com- plex problem.
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