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Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Stockholm, Sweden.ORCID iD: 0000-0003-4753-6745
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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. Vol. 22, no 1, p. 77-84
Keywords [en]
Mastery, Self-esteem, Sense of coherence, Hopelessness, Psychosocial, Coronary heart disease, Myocardial infarction
National Category
Clinical Medicine Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-108566DOI: 10.1007/s12529-014-9387-5ISI: 000349011500009PubMedID: 24430130OAI: oai:DiVA.org:liu-108566DiVA, id: diva2:730992
Available from: 2014-06-30 Created: 2014-06-30 Last updated: 2018-06-08Bibliographically approved
In thesis
1. Psychological Resources and Risk Factors in Coronary Heart Disease: Assessment, Impact and the Influence of Mindfulness Training
Open this publication in new window or tab >>Psychological Resources and Risk Factors in Coronary Heart Disease: Assessment, Impact and the Influence of Mindfulness Training
2018 (English)Doctoral 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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 114
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1623
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-148332 (URN)10.3384/diss.diva-148332 (DOI)9789176852873 (ISBN)
Public defence
2018-08-17, Berzeliussalen, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-06-08 Created: 2018-06-08 Last updated: 2018-07-27Bibliographically approved

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Lundgren, OskarGarvin, PeterJonasson, LenaAndersson, GerhardKristenson, Margareta

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