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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 5
| Issue : 1 | Page : 35-38 |
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Perceived heart risk factors can predict experienced psychological stress in outpatient cardiac rehabilitation
Mozhgan Saeidi1, Saeid Komasi2, Ali Soroush3, Behzad Heydarpour1
1 Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| Date of Web Publication | 30-May-2018 |
Correspondence Address:
Dr. Saeid Komasi
Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Zakarya Razi Boulevard, Kermanshah
Iran
 Source of Support: None, Conflict of Interest: None  | 3 |
DOI: 10.4103/ami.ami_91_17
Background: The study was done to investigate the role of perceived heart risk factors (PHRFs) in the prediction of psychological symptoms of cardiac rehabilitation (CR) patients. Methods: In this cross-sectional study, 124 CR patients referred to Kermanshah Hospital of Imam Ali were assessed during April–July 2015. PHRFs scale and Depression, Anxiety, and Stress scale-21 used for data collection. The data were analyzed using linear multiple regression analysis. Results: The mean age of samples (69.4% male) was 58.9 ± 9.7 years. The results of regression analysis evidenced that there is no significant relationship between any of the PHRFs with depression and anxiety (P > 0.05); however, biological (P = 0.018) and psychological (P = 0.019) risk factors significantly can predict stress. The model generally can explain 6.4% of the stress variance. Conclusion: PHRFs are included some significant predictors for experienced stress among the CR patients. Given that the biological and psychological risk factors are more effective in experienced stress by the patients, it is recommended that specialists pay more attention to the potential psychological outcomes of this group of patients.
Keywords: Cardiovascular disease, psychological symptom, rehabilitation, risk factor
How to cite this article:
Saeidi M, Komasi S, Soroush A, Heydarpour B. Perceived heart risk factors can predict experienced psychological stress in outpatient cardiac rehabilitation. Acta Med Int 2018;5:35-8 |
| Introduction | |  |
Psychological symptoms associated with cardiovascular diseases (CVDs) including stress, anxiety, and depression are among the most common illness outcomes [1],[2],[3] that it is a challenge for various age and sex groups.[4],[5] The psychological symptoms that are major causes of CVDs in 34% of patients [6],[7] make a significant impact on physical functioning, disability, and quality of life of cardiac patients and high levels of these symptoms increase the risk of sudden cardiac death up to three times.[1],[2] Although in the secondary prevention referred to cardiac rehabilitation (CR) programs as an effective comprehensive approach to reduce physical and mental symptoms,[4] the results of two studies showed that at the end of CR is not only not reduced depression and anxiety but also it will rise 10.7% and 16.7%.[1],[2] Hence, it seems that identifying factors associated with the symptoms can be effective in selecting the educational content of CR programs as well as early recovery of the patients.[8]
Perceived heart risk factors (PHRFs) are as one of the components that, in recent years, studies have been referred to it screening role for detecting psychological symptoms of cardiac patients,[1],[8] and it seems that the wider review of these factors can contribute to present knowledge in this field. According to Komasi and Saeidi suggestive model (2015), PHRFs consist of five categories including biological (gender, age, and family history), psychological (stress, anger, depression, and anxiety), environmental (pollution water and air, smoke and toxic substances, and war between countries), physiological (obesity, diabetes mellitus, high cholesterol, and high blood pressure), and behavioral factors (malnutrition, physical work pressure, smoking and substance abuse, and lack of exercise).[5],[8] According to the researchers' report, perceived physiological and psychological risk factors have a decisive role in identifying anxiety and depression among cardiac patients.[3],[8] Thus, since to identify factors associated with psychological symptoms of patients in the secondary prevention can be effective in physical recovery and return to normal life, it seems necessary to further study the relationship between PHRFs and psychological symptoms. Based on these considerations, we have designed this study to investigate the role of PHRFs in the prediction of psychological symptoms of CR patients.
| Methods | | |
In the cross-sectional study, 124 cardiac patients after referral to the CR of Kermanshah Hospital of Imam Ali (Western Iran) were invited to participate in the study during April–July 2015. The sample size required using the formula (N >50 + 8 m) was calculated and verified.[9] Inclusion criteria included age 30–80 years and no physical limitations to regular exercise. Data collection began after written informed consent to participate in the study. At first, demographic information and medical records of the patients were evaluated and recorded by the doctor of CR unit at 1 week before the start of exercise. At this phase, validated scales including PHRFs [10] and Depression, Anxiety, Stress Scale [11] were delivered to the patients by a clinical psychologist. The data were analyzed using Pearson's r correlation coefficient and linear multiple regression analyzes to examine the correlation between predictor and dependent variables (SPSS20 for Windows (IBM SPSS, Armonk, NY, USA) software). Before the regression analysis, nonviolation of all statistical assumptions (normality and outliers, linearity, independence of errors, and homoscedasticity) was checked and confirmed. All statistical tests were two sided; P ≤ 0.05 was considered statistically significant.
The perceived heart risk factors scale
The PHRFS is a 24-item self-report scale recently developed by Saeidi and Komasi.[10] It consists of five subscales that evaluate biological (three items), environmental (five items), behavioral (six items), psychological (seven items), and physiological risk factors (four items). Subscale total scores can be combined into a total score. Each item is rated on a 5-point Likert-type scale (0: never–4: very great), with higher scores indicating higher perceived risk factors. PHRF showed a moderate-to-good internal consistency (Cronbach's alpha for the total scale and subscales was 0.93, 0.63, 0.83, 0.82, 0.83, and 0.97, respectively), as well as a good content and construct validity.[10] In the present study, the internal consistency was 0.932.
The Depression, anxiety, and stress scale-21
This DASS is a 21-item self-report measure of psychological distress, originally developed by Lovibond and Lovibond.[11] It consists of three subscales that evaluate depression (seven items), anxiety (seven items), and stress (seven items). Each item is rated on a 4-point Likert-type scale (0 = did not apply to me at all and 3 = applied to me very much or most of the time). A previous study reported a good Cronbach's alpha and a good convergent validity with Beck Depression Inventory for the DASS.[12] In the present study, the internal consistency was 0.868.
| Results | | |
The range of age was 33–79 years with the mean (± standard deviation) 58.9 ± 9.7 years for all participants. Descriptive findings of the samples are visible in [Table 1].
In conjunction with the main analysis, the results of correlation between PHRFs and psychological symptoms are specified in [Table 2]. As can be observed, there is no significant relationship between any of the PHRFs with depression and anxiety (P > 0.05). Thus, the components cannot enter regression analysis. Furthermore, the results of [Table 2] revealed that the biological (P = 0.019) and psychological (P = 0.016) risk factors significantly associated with stress.
The results of regression analyses for stress are specified in [Table 3]. In the regression model for stress, P values associated with biological (β = 0.253, P = 0.025) and psychological risk factors (β = 0.301, P = 0.033) are significant. Thus, these risk factors are the most powerful predictors of stress. In total, the model summary shows that biological and psychological risk factors are significantly able to predict stress (F = 4.155, P = 0.018) and generally can explain 6.4% of the stress variance. | Table 3: The regression analyses for prediction of psychological symptoms
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| Discussion | | |
This study was done to investigate the role of PHRFs in the prediction of psychological symptoms of CR patients. The results of the present study showed that PHRFs, especially biological and psychological risk factors, are effective in predicting the experienced stress by CR patients. These findings are in line with previous reports.[3],[8],[13],[14] In relation to uncontrollable risk factors, we can refer to the viewpoint of Michie et al.[15] According to the researchers, having a feeling of control over the health consequences decreases the level of mental pressure.[15] Thus, it is natural to relate between uncontrollable risk factors and psychological symptoms such as stress.
The relationship between actual and perceived psychological risk factors is also consistent with previous studies.[13],[14] Apart from the fact that a significant proportion of cardiac patients consider the psychological factors as the etiology of their illness,[6],[7] usually those who really experience more stress identify the factors as an etiology.[3],[13],[14]
Clearly, the causal attitudes of patients in all stages of the illness such as identification of the disease signs and causes and modifying unhealthy behaviors has a important impact on the progression of the disease and it can play a decisive role in the health behavior of patients.[6],[7],[8],[13],[16] Given that the causal attributions of patients can independently predict the severity of psychological symptoms, evaluation of the patient's perception of the cause of illness likely is effective in the design of therapeutic intervention for them and may dramatically increase CR results.[3],[8] Generally, it seems that screening and scanning of psychological symptoms by the PHRFs during CR program has a significant impact on the quantity and quality of health care.[3],[5],[8]
We used DASS for assess anxiety that was unable to distinguish between trait and state anxiety. Furthermore, this instrument is not capable of evaluating the stress caused by life events. Therefore, it is better to use more appropriate tools in future studies. Due to the limited number of patients referred to outpatient CR, repeat this study in the phase of hospitalization can facilitate the generalization of the findings.
| Conclusion | | |
PHRFs are included some significant predictors for experienced stress among the CR patients. Given that the biological and psychological risk factors are more effective in experienced stress by the patients, it is recommended that specialists pay more attention to the potential psychological outcomes of this group of patients.
Acknowledgment
It is hereby deemed necessary to thank and appreciate the staff and patients of Cardiac Rehabilitation Unit of the Imam Ali Hospital of the Kermanshah University of Medical Sciences.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Saeidi M, Komasi S, Heydarpour B, Karim H, Nalini M, Ezzati P, et al. Predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation program. Res Cardiovasc Med 2016;5:e30091.  |
| 2. | Komasi S, Saeidi M, Montazeri N, Masoumi M, Soroush A, Ezzati P, et al. Which factors unexpectedly increase depressive symptom severity in patients at the end of a cardiac rehabilitation program? Ann Rehabil Med 2015;39:872-9. |
| 3. | Saeidi M, Komasi S, Heydarpour B, Momeni K, Zakiei A. Those who perceive their disease as a physiological or psychological risk factor experience more anxiety at the beginning of the cardiac rehabilitation program. Res Cardiovasc Med 2016;5:e29291. [Full text] |
| 4. | Komasi S, Saeidi M. What is role of sex and age differences in marital conflict and stress of patients under cardiac rehabilitation program? ARYA Atheroscler 2016;12:138-45. [ PUBMED] |
| 5. | Komasi S, Saeidi M. Aging is an important cause for a lack of understanding of the main risk factor in cardiac rehabilitation patients. Thrita 2015;4:e32751. |
| 6. | Saeidi M, Komasi S, Soroush A, Zakiei A, Shakeri J. Gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. J Cardio Thorac Med 2014;2:215-20. |
| 7. | Saeidi M, Soroush A, Komasi S, Moemeni K, Heydarpour B. Attitudes toward cardiovascular disease risk factors among patients referred to a cardiac rehabilitation center: Importance of psychological attitudes. Shiraz E Med J 2015;16:e22281. |
| 8. | Komasi S, Saeidi M. Screening for depressive symptoms at the beginning of outpatient cardiac rehabilitation by assessed perceived risk factors by patients. Clin Med Rev Case Rep 2015;2:8. |
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| 10. | Saeidi M, Komasi S. Reliability and validity of perceived heart risk factors scale. Ann Card Anaesth 2017;20:114-6. [ PUBMED] [Full text] |
| 11. | Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995;33:335-43. [ PUBMED] |
| 12. | Bahremand M, Saeidi M, Takallo F, Komasi S. Comparison of depression, anxiety, and stress between mild and severe non-cardiac chest pain. Thrita 2016;5:e32752. |
| 13. | Perkins-Porras L, Whitehead DL, Steptoe A. Patients' beliefs about the causes of heart disease: Relationships with risk factors, sex and socio-economic status. Eur J Cardiovasc Prev Rehabil 2006;13:724-30. [ PUBMED] |
| 14. | Soroush A, Komasi S, Saeidi M, Heydarpour B, Carrozzino D, Fulcheri M, et al. Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention. Ann Card Anaesth 2017;20:303-8. [ PUBMED] [Full text] |
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| 16. | Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A. Causal beliefs, cardiac denial and pre-hospital delays following the onset of acute coronary syndromes. J Behav Med 2008;31:498-505. [ PUBMED] |
[Table 1], [Table 2], [Table 3]
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