FREQUENCY OF ANXIETY AND PSYCHOSOCIAL STRESSFUL EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFRACTION

Authors

  • Mohammad Asghar Khan
  • Mehwish Karamat
  • Mohammad Hafizullah
  • Zahid Nazar
  • Muhammad Fahim
  • Adnan Mehmood Gul

Abstract

Background: The impact of psychological factors in acute coronary events is only now emerging. Agrowing body of evidence attests to the influence of emotional and stress-related psychosocialfactors in the aetiology of Coronary Artery Disease (CAD) and morbidity and mortality amongindividuals with coronary heart disease. The objectives were to look for the frequency of anxiety andpsychosocial stressful events in patients with acute myocardial infarction. Methods: Two hundredconsecutive patients of Acute Myocardial Infarction (AMI) without complications who presented tothe Coronary Care Unit of Cardiology Department, Lady Reading Hospital Peshawar, and 200healthy controls among relatives of patients were assessed on Holmes Rahe Social scale (HRS) andHospital Anxiety and Depression Scale (HADS) scale for the presence of anxiety and stressful lifeevents in period preceding AMI. Results: Sixty-three percent of the patients were male in bothgroups. Mean age of patients was 59 years while that of controls was 52 years. For scores of anxietyon HADS, 34% of the controls had normal score compared to of the 19% AMI group (p<0.001),while 57% of the AMI patients had abnormal score compared to 39% of the control group (p<0.001).The number events reported on HRS scale in patients with AMI were significantly more (4.2±2)compared to the number of events (2.7±1.6) in the control group with (p<0.001). Scores for thenumber of events on HRS scale were significantly less (98±64) in controls compared to (158±5.8) ingroup with AMI (p<0.001). Anxiety was diagnosed in 70% of the female patients compared to 50%of the male patients. Conclusion: Significant number of patients with acute myocardial infarctionwhen assessed on standard scales had anxiety and stressful life events in the weeks preceding theevent. These were more common in female than male patients.Keywords: Anxiety, Stress, Myocardial Infarction, Coronary, HADS

References

Pignalberi C, Ricci R, Santini M. Psychological stress and

sudden death. Ital Heart J 2002;3:1011–21.

Kinjo K, Sato H, Sato H, Shiotani I, Kurotobi T, Ohnishi Y,

et al. Variation during the week in the incidence of acute

myocardial infarction: increased risk for Japanese women on

Saturdays. Heart 2003;89:398–403.

Dimsdale JE. Psychological Stress and Cardiovascular

Disease. J Am Coll Cardiol 2008;51:1237–46.

ENRICHD Investigators. Enhancing recovery in coronary

heart disease (ENRICHD) study intervention: rationale and

design. Psychosom Med 2001;63:747–55.

Dimsdale JE. Psychological Stress and Cardiovascular

Disease. J Am Coll Cardiol 2008;51:1237–46.

Hemingway H, Kuper H, Marmot M. Psychosocial factors in

the primary and secondary prevention of coronary heart

disease: an updated systematic review of prospective cohort

studies. In: Yousaf S, Cairns JA, Camm AJ, Fallen EL, Gersh

BJ, eds. Evidence-Based Cardiology, 2nd ed. London: BMJ

Books;2003.p. 181–218.

Smith TW, Ruiz JM. Psychosocial influences on the

development and course of coronary heart disease: current

status and implications for research and practice. J Consult

Clin Psychol 2002;70:548–68.

Rozanski A, Blumenthal JA, Davidson KW, Saab PG,

Kubzansky L. The epidemiology, pathophysiology, and

management of psychosocial risk factors in cardiac practice:

the emerging field of behavioral cardiology. J Am Coll

Cardiol 2005;45:637–51.

Jakobsen AH, Leslie Foldager L, Parker G, Munk-Jørgensen

P. Quantifying links between acute myocardial infarction and

depression, anxiety and schizophrenia using case register

databases. J Affective Disord 2008;109:177–81.

Akhtar MS, Khan MA, Malik SB. Psychosocial factors

associated with symptoms of depression and anxiety

following Acute Myocardial Infarction. Pak J Med Sci

;24(2):192–7.

Moser DK, Dracup K. Is anxiety early after myocardial

infarction associated with subsequent ischemic and

arrhythmic events? Psychosom Med 1996;58:395–401.

Chockalingam A, Venkatesan S, Dorairajan S, Moorthy C,

Chockalingam V, Subramaniam T. Estimation of Subjective

Stress in Acute Myocardial Infarction. J Postgrad Med

;49:207–10.

Zigmond AS, Snaith RP. The Hospital Anxiety and

Depression Scale. Acta Psychiatrica Scandinavica

;67:361–70.

Holmes TH, Rahe RH. The Social Readjustment Rating

Scale. J Psychosom Res 1967;11:213–8.

Mayou RA, Gill D, Thomson DR, Day A, Hicks N, Volmink

J, Neil A. Depression and anxiety as predictors of outcome

after myocardial infarction. Psychosom Med 2000;62:212–9.

Mcculloch J. Hospital anxiety and depression in myocardial

infarction patients. Br J Cardiol 2007;14:106–8.

Rahe RH, Mahan JL, Arthur RJ. Prediction of near-future

health change from subjects’ preceding life changes. J

Psychosom Res 1970;14:401–6.

Dickens CM, McGowan L, Percival C, Tomenson B, Cotter

L, Heagerty A, et al. Lack of a close confidant, but not

depression, predict further cardiac events after myocardial

infarction. Heart 2004;90:518–22.

Chockalingam A, Vankatesan S, Dorairajan S, Chockalingam

V, Subramanain T. Esimation of subjective stress in acute

myocardial infarction. J Postgrad Med 2003;49:207–10.

Yusaf S, Hawken S, Oupuu S, Dans T, Avezum A, Lanas F,

et al. Effect of potentially modifiable risk factors associated

with myocardial infarction in 52 countries (the

INTERHEART Study): case control study. Lancet

;364:937–52.

Nishtar S. Coronary artery disease burden in Pakistan —A

review. J Pak Inst Med Sci 2001;8(12):592–4.

Khan MA, Mahmood ul Hassan, Mohammad Hafizullah.

Coronary Artery Disease, Is it more frequently effecting

younger age group and women? Pak Heart J 2006;39:17–21.

Wattoo FH, Memon MS, Memon AN, Wattoo MHS, Tirmizi

SA, Iqbal J. Effect of stress on serum lipid levels in lady

health visitors and housewives. Rawal Med J 2007;32(1):4–4.

Marrugat J, Garcia M, Elosua R, Aldasoro E, Omro MJ,

Zurriaga O, et al. Short-term (28 days) prognosis between

genders according to the type of coronary event (Q-wave

versus non-Q-wave acute myocardial infarction versus

unstable Angina pectoris). Am J Cardiol 2004;94:1161–5.

Guriro A. Suicides rising in Karachi. Daily Times. Monday,

August 2008 available at http/www.dailytimes.com.pk/08.

Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M,

Almahmeed WA et al. Association of psychosocial risk

factors with risk of acute myocardial infarction in 11119

cases and 13648 controls from 52 countries (the

INTERHAERT study): case control study. Lancet

;364:953–62.

Downloads

Published

2010-06-01

Most read articles by the same author(s)

1 2 > >>