A Biopsychosocial Investigation of Depression and Quality of Life Outcomes in Coronary Artery Bypass Graft Patients PDF Download

Author: Cheryl Remedios
Publisher:
ISBN:
Category : Coronary artery bypass
Languages : en
Pages : 214

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Author: Jo-Ann Eastwood
Publisher:
ISBN:
Category :
Languages : en
Pages : 440

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Author: Derek Bolton
Publisher: Springer
ISBN: 3030118991
Category : Psychology
Languages : en
Pages : 149

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Book Description
This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have occurred since the model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social.

Author: Raja Sekhar Padala
Publisher: LAP Lambert Academic Publishing
ISBN: 9783659619113
Category :
Languages : en
Pages : 148

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This book provides valuable insights into the psychological aspects of coronary artery bypass graft.Chronic diseases are multidimensional and have the potential to affect many aspects of the individual's life. Cardiovascular diseases take the person and family through various phases of instability, with hospital admissions for complex inpatient procedures such as angioplasty and surgery. These experiences are part of the adaptation of the individual to the chronic condition of the disease, affecting his or her quality of life. Finally, life styles and stress plays a crucial role in maintaining good health.

Author:
Publisher:
ISBN:
Category : Adjustment (Psychology)
Languages : en
Pages : 97

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There is growing evidence suggesting health behaviors (e.g., physical activity, medications) significantly improve health outcomes and quality of life following coronary artery bypass graft (CABG) surgery. Despite the clear benefits of these behaviors, adherence is poor and interventions designed to promote them have yielded mixed results. This dissertation, guided by Leventhal's Commonsense Model of Self-Regulation (CSM) and Bandura's Social Cognitive Theory (SCT), was a descriptive study designed to identify beliefs that might predict adherence and serve as intervention targets. Participants were 89 CABG (M age = 65.4, 73% male, 79.8% white) surgery patients who spoke English and were free of any neurological, cognitive, or medical condition that might influence their ability to complete the study. They were interviewed prior to surgery about their CSM and SCT beliefs and their health behaviors (i.e., physical activity, medication adherence) using structured interviews. All measures exhibited factor structures that fit with a priori expectations and had acceptable reliability ([alpha]s between .67 and .91). Demographic information was gathered during the structured interviews. Medical information was gathered from medical records and aggregated to create a single cardiac risk factor index. Results suggested that personal control and emotional cause beliefs were positively associated with physical activity, whereas medical cause beliefs were inversely associated with physical activity. In addition, the relationship between symptoms and physical activity appeared to be statistically mediated by emotional cause beliefs. With regard to SCT beliefs, negative medication outcome expectancies (NMOE) was inversely associated with medication adherence, and the relationship between medication adherence self-efficacy and medication adherence was statistically mediated by NMOE. Examination of the possible moderating influence of symptoms on beliefs suggested that both self-efficacy and bed rest outcome expectancies were associated with physical activity if an individual was symptomatic but they were not associated with physical activity if an individual was asymptomatic. Overall, results suggest that integrating the CSM with SCT provides a useful conceptual framework for understanding medication adherence and physical activity. Future research is required to evaluate the prospective, predictive utility of this framework. In addition, interventions that are tailored to patients' symptom status seem worth pursuing.

Author: Amaris Tippey
Publisher:
ISBN:
Category :
Languages : en
Pages : 177

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Introduction: Rates of heart failure have been increasingly noticed in individuals between 20 and 50 years of age, especially in Eastern North Carolina. Little is known about this subset of patients with heart failure. The paucity of literature is problematic as diagnosis at younger developmental stages likely leads to more unique self-care and psychosocial implications for these individuals that may have an impact on heart failure outcomes. The aims of the study were to conduct a biopsychosocial assessment of young adult patients with heart failure and to identify psychosocial priorities for intervention with young adults with heart failure, specifically examining the relationships between heart failure self-care adherence, perceived fit within one's social group, and depression/anxiety. Method: A preliminary qualitative interview study was conducted with 7 young heart failure patients to aid in the conceptualization of the quantitative study. For the primary study, a sample of 46 heart failure patients between the ages of 20 and 50 completed a survey packet encompassing demographic, medical, psychological, and social domains. Results: Overall, the majority of the sample endorsed inadequate adherence (70%) and only 28% reported knowing that heart failure would shorten their life expectancy likely indicating limited disease knowledge in many patients. Overall, reports of annual income were low secondary to unemployment related to heart failure diagnosis. Also, the high rates of psychological distress in this sample were notable. Hypothesized relationships between heart failure self-care adherence and the aforementioned domains were partially supported. Independent t-tests revealed significant differences between patients classified as having good adherence and those classified as having inadequate adherence. Patients with inadequate adherence reported increased levels of depression, lower future expected quality of life, more dignity concerns, lower self-care confidence, less perceived fit with one's social group, and less total coping skills than patients who reported good self-adherence. In addition, correlational analyses indicated that lower perceived group fit was related to higher rates of depression and anxiety, worse heart failure self-care adherence, worse quality of life, and more dignity concerns. Further, there were no significant differences on any of the aforementioned domains between individuals who endorsed knowing another individual under 50 with heart failure versus those who did not. Finally, the hypothesis that perceived group fit would moderate the relationships between heart failure self-care adherence and psychosocial variables was not supported. Conclusions: Based on these findings, social comparisons in regard to perceived group fit, heart failure education and psychoeducation on the relationships between psychosocial symptoms and adherence, and building coping skills were identified as key intervention priorities for young adults diagnosed with heart failure. It was further proposed that the treatment modality for future interventions be a group format utilizing the harm reduction relapse prevention model as a contextual framework to aid in increased adherence and reduced psychological distress.

Author: Adrienne Elizabeth O'Neil
Publisher:
ISBN:
Category :
Languages : en
Pages : 558

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Background: Depression is highly prevalent in cardiac populations. While depression can lead to a range of clinical and psychological impairments, its impact on vocational, mental and physical health functioning remains under-researched in this population. Also unclear is whether targeted treatment can improve these outcomes. Combining depression management with a Coronary Heart Disease (CHD) secondary prevention program using a flexible mode of delivery could facilitate access to treatment, improving these patient outcomes and minimising the burden of this co-morbidity. The purpose of this thesis was to assess the impact of depression on mental, physical and vocational functioning in those with cardiovascular disease (CVD), and determine whether targeted treatment can improve these outcomes. Methods: Australian population-based data were used to assess the burden of, and interaction between, major depressive disorder (MDD) and CVD on vocational and health related quality of life (HRQOL) outcomes. Further, a novel systematic review was conducted to determine the predictive role of depression on return to work (RTW) after a cardiac event. In order to determine the effectiveness of depression treatment on mental and physical HRQOL outcomes of cardiac patients, a meta-analysis was conducted. Finally, data from a two-arm, 24-week randomised feasibility trial, with 6-month evaluation outcomes, were used to assess the effectiveness of a telephone-delivered, depression and lifestyle management program ('MoodCare') on mental and physical HRQOL and vocational functioning of depressed Acute Coronary Syndrome patients. Results: First, Australians with co-morbid MDD and CVD were least likely to be participating in the workforce (adj. Odds Ratio (OR): 0.4, 95% CI:0.3-0.6), and most likely to experience work functioning impairments (adj. OR:8.1, 95% CI:3.8-17.3) and absenteeism (adj. OR:3.0, 95% CI:1.4-6.6) when compared with individuals with one or neither condition. Second, depression predicted RTW after a cardiac event in over half of the 12 studies reviewed. Third, Australians with co-morbid MDD and CVD reported the greatest deficits in Assessment of Quality of Life (AQOL) utility scores (adj. Coefficient:-0.32, 95% CI:-0.40,-0.23) when compared with those with one or neither condition. Fourth, a meta-analysis demonstrated that depression treatment administered after a cardiac event significantly improved both mental and physical health functioning. Effect sizes were greatest for mental (standardised mean difference [SMD]=-0.29, 95% CI:-0.38,-0.20) versus physical HRQOL (SMD:-0.14, 95% CI:-0.24,-0.04). Finally, the MoodCare program yielded significant improvements in physical health functioning after 6-months (SF-12 mean difference=6.7; 95% CI:1.1, 12.3), compared with a control condition. Significant improvements in mental health functioning were also observed for those with a history of MDD. No intervention effects were observed for vocational outcomes.Conclusions: These findings confirm co-morbid depression and CVD as a significant public health issue. The benefits of treating depression in this population can go beyond psychological outcomes to improve HRQOL. These findings provide support for the use of a combined depression management and lifestyle program which is delivered over the telephone to improve key functioning outcomes of cardiac patients. Further research is required to determine the most effective way to impact vocational outcomes. Several clinically- and policy-relevant recommendations are discussed in light of these findings.

Author: Alexis Wheeler
Publisher:
ISBN:
Category : Autonomic nervous system
Languages : en
Pages : 333

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Book Description
Mental health, such as depression, and cardiovascular disease, such as coronary heart disease (CHD), are among two of the priority areas for health care and research in Australia and worldwide, and share many commonalities. First, depression and CHD are highly prevalent and frequently co-exist. Individually and together, they impose a significant burden of disease. Lastly, a reciprocal relationship exists, such that depressive symptoms are risk factors for the onset and progression of CHD (and vice versa), contributing to further morbidity, decreased quality of life (QoL) and mortality. The autonomic nervous system (ANS) has been implicated in the relationship between depression and CHD; and specifically, reduced heart variability (HRV; a marker of ANS activity) has been associated with both CHD and depression. Accordingly, psychological treatments with potential to enhance HRV (such as mindfulness-based cognitive therapy [MBCT]) may offer significant benefits to patients with either or both diagnoses. This thesis utilised quantitative statistical analyses to investigate the mental health of Australians, focusing on some actual and potential relationships between CHD, HRV and depression. Three independent but related studies were undertaken. The three published manuscripts, and some additional unpublished results, are presented as chapters in the thesis. Chapter One provides a context to this research, providing a comprehensive introduction to the literature on depression and its treatment MBCT, cardiac function and CHD, the relationships between depression and CHD, the ANS and HRV. Chapter Two outlines specific gaps identified in the literature leading to the thesis objectives. Chapter Three describes study measurement and types of psychometric questionnaires utilised. The three published manuscripts are then presented in Chapters Four to Six. Pre-existing datasets were used to investigate the demographic, psychological and cardiac factors associated with depression (Study 1) and subsequent mortality (Study 2) in cardiac patient samples. A clinical pilot study (Study 3) was then designed and conducted to investigate changes in physiology among mental health outpatients undergoing MBCT. A number of methods were employed to evaluate patient outcomes in the three studies. The major end points of this research focused upon patient-reported health and psychological measures (i.e., depression and QoL) and cardiac measures (i.e., HRV). Cross-sectional and longitudinal analyses were conducted using appropriate statistical analyses. Cross-sectional data were analysed using binary regression or Cox's proportional hazards model (Studies 1 and 2) whereas longitudinal data were analysed as panel data, utilising random effects model and logistic regression (Study 3). A summary of findings, strengths and weaknesses of the three studies and their implications for future research and clinical practice form the discussion (Chapter Seven). Findings from the three studies have contributed to the epidemiological literature by providing empirical support for the relationships between depression and CHD, and between depression and mortality; and to evidence-based practice by reporting pilot data and methodological considerations concerning evaluation of the potential impact of MBCT on HRV. It is believed that results of this research will contribute to understanding the course and outcomes of depression in CHD and have implications for managing this comorbid condition.

Author: Patricia Thomson
Publisher:
ISBN:
Category :
Languages : en
Pages :

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Background: Coronary heart disease (CHD) remains a major cause of death and ill-health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest. Aim: To explore the complex factors that influence patient and partner and dyad outcome 4 months after CABG surgery. Design and methods: A multifactorial exploratory, prospective study was carried out. A consecutive sample of 80 patient-partner/family pairs were recruited and data were collected on a number of physical and psychosocial variables 2-3 months prior to elective CABG and 4 months after surgery. The outcome measures were perceived health status, quality of life and CHD risk factors. Findings: The patients' CHD risk factors and physical and mental health (SF-12) improved significantly from pre- to post-operatively, but there was no corresponding improvement in the partners. Most patients were free from angina following CABG. Though the partners' quality of life improved it remained sub-optimum post-operatively. The patients' self efficacy beliefs and partners' efficacy judgements about the patient's cardiac capabilities improved significantly at 4 months; treatment beliefs were unchanged. The patients' perceived social support improved post-operatively, but not the partners. Patients' and partners' total number of important need met increased significantly post-operatively, and the number of important needs unmet decreased. There were significant differences between the patient and partner groups over the two time periods (pre- and post-operatively) for CHD risk factors, physical health (SF-12), self-efficacy for maintaining function, affectionate support, positive social interaction and important needs met and unmet. Overall, the recovery patterns indicated a move towards concordance. The patients' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical health, and lower pre-operative importance need met predicted poorer mental health. Greater pre-operative CHD risk factors and being female predicted higher post-operative risk factors. Partners' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical and mental health; low pre-operative affectionate support predicted poorer physical and social health (QL-SP); and a greater number of pre-operative CHD risk factors predicted higher post-operative risk factors. The patients' pre-operative beliefs about CABG - mortality risk reduction predicted the partners' poorer post-operative physical health (SF-12) and emotional health (QL-SP); and patients' poorer pre-operative mental health (SF-12) and greater physical limitation (SAQ) predicted the partners' poorer physical and social health (QL-SP). Only the partners' poorer pre-operative physical health predicted patients' poorer post-operative physical health (SF-12). This unidirectional relationship in which the patients' pre-operative factors predominantly influenced partner outcome(s) was also evident when the physical and mental health and CHD risk factors of the dyad (outcomes) were examined. Results highlight the potential that pre-operative rehabilitation and use of interventions, which target the dyad have for the primary and secondary prevention of CHD. Nurses are heavily involved in the pre-operative preparation for CABG and in the post-operative care of patients and could contribute further to improving the outcomes of surgery for patients and partners.

Author: Heng-Hsin Tung
Publisher:
ISBN:
Category : Coronary artery bypass
Languages : en
Pages : 142

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Book Description
Coronary artery bypass grafting surgery (CABG) is a stressful event and requires coping strategies to achieve adaptation. In Taiwan, despite the fact that the incidence of CABG is increasing in both men and women, research on post-CABG adaptation is very limited and no research focuses on outcomes for women. This can lead to problems for health care providers who lack effective interventions to help these patients. The purpose of the study was to examine the relationship between coping, anxiety, and quality of life in Taiwanese post-CABG patients. A cross-sectional correlational design was used; the sample consisted of 50 female and 50 male patients. A post-hoc analysis was employed to understand whether the patients understood the words used in the instruments. To provide more depth to the findings, semi-structured interviews with three male and three female participants were conducted. The literature indicated that the variables' effect on quality of life varied across studies. In the present study, ways of coping, anxiety, and quality of life interacted and influenced each other. Post-CABG patients who were male and had more role responsibility, experienced lower levels of anxiety and used problem-focused coping; as a result, were more likely to obtain a better quality of life. Anxiety was a good predictor of adaptation outcome and was negatively associated with problem-focused coping. Additionally, mental health predicted greater use of problem-focused coping. The results of the semi-structured interview indicated that the quantitative findings were valid and reliable. Men still adapted better than did the women. Both men and women were concerned about their physical recovery following CABG, but men tended to make plans to take control of their health, while women tended to seek help to overcome their stress. The semi-structured interviews provided richness to the study that could not have been captured by quantitative findings alone. The interview responses raised questions about the effect of personality, worldview, culture, anxiety, coping, and perceptions on quality of life that need to be further explored.