The Effect Of Cognitive Behavioral Intervention On Perceived Control, Anxiety And Depression In Hospitalized Patients With Coronary Heart Disease

Objective①To translate the Chinese version of CAS-R, and examine the reliability and validity of the scale.②To assess perceived control of hospitalized patients with CHD, and to explore its affecting factors.③To investigate the correlation between perceived control and anxiety, depression.④To evaluate the effect of cognitive behavioral intervention on perceived control, anxiety and depression in hospitalized patients with coronary heart disease.Methods①Translated the English version of the Control Attitudes Scale-Revised (CAS-R) into Chinese. Correlation coefficient were used to delete or retain an item. Content validity and construct validity were used to verified validity. Cronbach’s a coefficient, test-retest reliability and split-half reliability were used to verified reliability.②Selected106coronary heart disease patients from the second Xiangya hospital of Central South University to be samples, who were randomly divided into control group and intervention group with each group53cases. Patients in both group were given routine care, such as observation, psychological care, medication care, specialized care, health education, and so on. While patients in intervention group received five times of cognitive behavioral intervention with20to40min per time additionally, which including reconstruction of cognitive and problem-solving training. All patients were measured perceived control, anxiety and depression by the Chinese version CAS-R, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) respectively pre-intervention, post-intervention and3months after intervention.Results①Correlation coefficients of item score and total score ranged from0.539～0.769. Validity verification:the correlations between items and total scores ranged from0.539to0.769; exploratory principal cmponent analysis of the items indentified that the scale had1factors; the content validity index of CAS-R was0.875. Reliability verification: the Cronbach’s a coefficient for the CAS-R was0.806; the test-retest reliability coefficient was0.813, the split-half reliability coefficient was0.781.②The average score of CAS-R was (27.17±4.78) in hospitalized patients with CHD. Number of complications, NYHA classification, myocardial infarction and gender were the main influential factors of CAS-R.③CAS-R score was negatively correlated with SAS and SDS score (P<0.01).④Effect on the CAS-R score of intervention:the difference value of CAS-R score before and after intervention was not statistically significant in control group (P>0.05), while statistically significant in intervention group (P<0.05); the difference value of CAS-R score before and after intervention in intervention group was larger than that of control group (P<0.05):there were statistically significant in main effect of intervention, main effect of time and the interaction effects (P<0.05).⑤Effect on SAS score and incidence of depression of intervention:the difference values of SAS score before and after intervention both in control group and intervention group were statistically significant (P<0.05); the difference value of SAS score before and after intervention in intervention group was larger than that of control group (P<0.05); there were statistically significant in main effect of intervention, main effect of time and the interaction effects (P<0.05); there was statistically significant difference in the incidence of anxiety after the intervention between the two groups (P<0.05), while no statistically significant difference before intervention and three months after intervention (P>0.05).⑥Effect on SDS score nd incidence of depression of intervention:the difference values of SDS score before and after intervention both in control group and intervention group were statistically significant(P<0.05); the difference value of SDS score before and after intervention in intervention group was larger than that of control group (P<0.05); there were statistically significant in main effect of intervention, main effect of time and the interaction effects (P<0.05); there was statistically significant difference in the incidence of depression after the intervention between the two groups (P<0.05), while no statistically significant difference before intervention and three months after intervention (P>0.05). Conclusions①The validity and reliability of the Chinese version of CAS-R were all achieved good to excellent levels through psychometric properties analyzing and internal analyzing.②Perceived control was low in hospitalized patients with CHD. The main influential factors of CAS-R were number of complications, NYHA classification, myocardial infarction and gender.③Perceived control were negatively correlated with anxiety and depression in patients with coronary heart disease.④Cognitive behavioral intervention can effectively enhance perceived control in hospitalized patients with CHD, and this effect still exists3months after intervention. To some extent, cognitive behavioral intervention can reduce patients’s anxiety and depression.