ROLE OF DIFFERENT DETERMINANTS OF PSYCHOLOGICAL DISTRESS IN ACUTE CORONARY SYNDROMES

Objectives. The aim of this study was to examine the prevalence of psy chological distress and of its major determinants in acute coronary pa tients and in a central group. Background. The prevalence and major de terminants of psychological distress in acute coronary patients are no t clear. Methods. One hundred and thirty cardiac patients (110 men, ag e 56 +/- 9; 85 with acute myocardial infarction and 45 with unstable a ngina) and 102 controls hospitalized for acute trauma (70 men, age 55 +/- 9 years) were studied and the level of psychological distress esti mated by a Modified Maastricht Questionnaire, self-ratings and ratings by a close relative. Major determinants of psychological distress wer e assessed by the Life Events Assessment, the Social Support Questionn aire and the Ways of Coping Checklist. Results. The average level of p sychological 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; Mod ified Maastricht Questionnaire = 91 +/- 32 vs 59 +/- 30). Cardiac pati ents reported significantly higher (p < 0.05) levels of social isolati on (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 subgrou ps,,vith one or more determinants of distress, comprised about 75% of patients and only 25% of controls, Conclusions. These results show tha t a high level of psychological distress is detectable in about 75% of patients with acute myocardial infarction or unstable angina and is r elated to one or more major determinants. (J Am Coil Cardiol 1998;32:6 13-9) (C) 1998 by the American College of Cardiology.