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  • Public defence: 2018-08-14 13:00 Berzeliussalen, Linköping
    Lundgren, Oskar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Psychological Resources and Risk Factors in Coronary Heart Disease: Assessment, Impact and the Influence of Mindfulness Training2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is strong evidence for the observation that psychological risk factors, such as depressive symptoms, hopelessness, and anxiety are associated with higher risk of developing coronary heart disease (CHD), and also contribute to a worse prognosis among CHD patients. Much less is known about psychological resources, such as Mastery, and their role in cardiovascular medicine. Although the current state of science about the importance of psychological factors has advanced during the last decades, the mental health status of patients is often neglected in clinical practice. The reason behind this gap is multifaceted, including unawareness of the current state of science among professionals and a lack of clear guideline, which in turn, results from a lack of evidence-based ways to address the issues. Furthermore, the measurement of psychological resources is complex and a debated topic in psychology. The aim of this thesis was to investigate: 1) If the use of inverted items in three questionnaires that measure psychological resources and risk factors represent a validity risk in the context of CHD. 2) If psychological resources and risk factors are independently associated with incidence in CHD. 3) If an eight-week course in Mindfulness-Based Stress Reduction (MBSR) is a feasible psychological intervention, as an addition to cardiac rehabilitation. 4) How CHD patients experience the practices of mindfulness and yoga in MBSR.

    In Study I and II, data from 1007 participants randomly selected from a Swedish community sample, aged 45-69 at baseline (50 % women), were analysed. To study the validity of the self-report instruments Mastery, Self-esteem and Centre for Epidemiological Studies Depression scale (CESD), subscales with only positive and negative items were created. The new subscales were evaluated against three criterion measures; cross-sectional against each other and the circulatory marker of inflammation interleukine-6 (IL-6) (concurrent construct validity); prospectively against 8-year incidence in CHD (predictive validity), and in addition, a factor analysis was used to investigate construct dimensionality. The instruments seemed to be valid measures of psychological resources and risk factors in the context of CHD risk. The new subscales showed the same associations as the original scales, except for the positive items in CES-D. However, this did not have a major influence on the full scale. In Study II a prospective analysis of the impact of psychological factors on 8-year incidence in CHD was performed. The psychological resources Mastery and Self-esteem were negatively associated with CHD, also after adjustment for nine traditional cardiovascular risk factors in Cox proportional hazard models. The protective effect of the two resources, and the increased risk of Hopelessness, remained after adjustment for depressive symptoms. In Study III and IV, a group of CHD patients with depressive symptoms (n=79) was invited to participate in MBSR as a complement to cardiac rehabilitation. Twenty-four patients started MBSR and 16 completed it. The results were compared with a reference group (n=108) of patients from the same clinic, which showed stability in psychological variables over 12 months. MBSR was appreciated by the patients and improvements in psychological risk factors (e.g., depressive symptoms), and an increase in Mastery were observed. Study IV made use of a qualitative content analysis of diary entries written by patients immediately after practice sessions throughout MBSR. Participants described difficulties, both physical and psychological, during the whole course, but as the weeks passed they more frequently described an enhanced ability to concentrate, relax and deal with distractions. From the combined findings in Study III and IV, we conclude that MBSR could be a promising complement to cardiac rehabilitation for a selection of patients.

    The overall picture, emerging from this thesis, strengthens the argument that psychological factors should be recognized and addressed in clinical practice. It also encourages further studies of how psychological resources could be built, which could inform the development of effective prevention and treatment strategies for CHD patients with psychological distress and also contribute to improved public health interventions.

    List of papers
    1. Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale
    Open this publication in new window or tab >>Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale
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    2018 (English)In: Health psychology open, ISSN 2055-1029, Vol. 5, no 1, article id 2055102918755045Article in journal (Refereed) Published
    Abstract [en]

    Psychological resources and risk factors influence risk of coronary heart disease. We evaluated whether inverted items in the Self-esteem, Mastery, and Center for Epidemiological Studies Depression scales compromise validity in the context of coronary heart disease. In a population-based sample, validity was investigated by calculating correlations with other scales (n = 1004) and interleukin-6 (n = 374), and by analyzing the relationship with 8-year coronary heart disease risk (n = 1000). Negative items did not affect the validity of the resource scales. In contrast, positive items from Center for Epidemiological Studies Depression showed no significant relationships with biological variables. However, they had no major impact on the validity of the original scale.

    Place, publisher, year, edition, pages
    Sage Publications, 2018
    Keyword
    coronary heart disease, depressiveness, interleukin-6, mastery, self-esteem, wording effect
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-146087 (URN)10.1177/2055102918755045 (DOI)29479456 (PubMedID)
    Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-06-08Bibliographically approved
    2. Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample
    Open this publication in new window or tab >>Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample
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    2014 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, no 1, p. 77-84Article in journal (Refereed) Published
    Abstract [en]

    Background

    A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.

    Purpose

    The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.

    Methods

    The cohort consisted of 484 men and 497 women, aged 45–69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.

    Results

    A total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).

    Conclusions

    The psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts

    Place, publisher, year, edition, pages
    Springer, 2014
    Keyword
    Mastery, Self-esteem, Sense of coherence, Hopelessness, Psychosocial, Coronary heart disease, Myocardial infarction
    National Category
    Clinical Medicine Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-108566 (URN)10.1007/s12529-014-9387-5 (DOI)000349011500009 ()24430130 (PubMedID)
    Available from: 2014-06-30 Created: 2014-06-30 Last updated: 2018-06-08Bibliographically approved