Role of different determinants of psychological distress in acute coronary syndromes

Objectives. The aim of this study was to examine the prevalence of psychological distress and of its major determinants in acute coronary patients and in a central group. Background. The prevalence and major determinants of psychological distress in acute coronary patients are not clear. Methods. One hundred and thirty cardiac patients (110 men, age 56 +/- 9; 85 with acute myocardial infarction and 45 with unstable angina) and 102 controls hospitalized for acute trauma (70 men, age 55 +/- 9 years) were studied and the level of psychological distress estimated by a Modified Maastricht Questionnaire, self-ratings and ratings by a close relative. Major determinants of psychological distress were assessed by the Life Events Assessment, the Social Support Questionnaire and the Ways of Coping Checklist. Results. The average level of psychological distress was significantly higher (p < 0.001) in coronary patients than in controls in all tests (self-evaluation = 7.1 +/- 2.3 vs 4.3 +/- 2.4; relative-evaluation = 7.4 +/- 2.4 vs 4.2 +/- 2.5; Modified Maastricht Questionnaire = 91 +/- 32 vs 59 +/- 30). Cardiac patients reported significantly higher (p < 0.05) levels of social isolation (28.9 +/- 11.1 vs 23.4 +/- 8.8), self-blame (7.2 +/- 1.9 vs 5.8 +/- 1.6) and avoidance (21.1 +/- 3.5 vs 18.9 +/- 3) and more painful life events (3.9 +/- 3.8 vs 2.6 +/- 2.2), than controls. However, not all patients had evidence of distress; indeed, cluster analysis identified a subgroup that comprised 75% of controls and 25% of cardiac patients with no determinants eliciting distress, while the other four subgroups,,vith one or more determinants of distress, comprised about 75% of patients and only 25% of controls, Conclusions. These results show that a high level of psychological distress is detectable in about 75% of patients with acute myocardial infarction or unstable angina and is related to one or more major determinants. (J Am Coil Cardiol 1998;32:613-9) (C) 1998 by the American College of Cardiology.