| Objectives1.To investigate the current state and the related influential factors of anxiety,depression and subjective well-being in patients with coronary heart disease undergoing percutaneous coronary intervention,and to provide scientific basis for development of a targeted psychological intervention model.2.To develop a psychological intervention program for patients with coronary heart disease undergoing percutaneous coronary intervention,and to test the improvement of the program on anxiety,depression and subjective well-being through a clinical psychological intervention trial,and to provide scientific and effective methods for the improvement of mental health in patients with coronary heart disease undergoing percutaneous coronary intervention.Methods1.The levels of anxiety,depression and subjective well-being were evaluated by self-rated anxiety scale,self-rated depression scale and general well-being schedule among patients with coronary heart disease undergoing percutaneous coronary intervention from a tertiary hospital in Nanjing.2.On the basis of current survey,literature review and expert advice,a framework of psychological intervention program for patients with coronary heart disease undergoing percutaneous coronary intervention based on cognitive behavioral therapy and positive psychological intervention were initially established,after the preliminary experiment,the final program for psychological intervention in patients with coronary heart disease undergoing percutaneous coronary intervention was determined.3.Empirical application.In July 2017,three wards from the Department of Cardiology in Zhongda Hospital Affiliated to Southeast University were selected as the study area.They were randomly divided into positive psychological intervention group,cognitive behavior intervention group and control group.The sample contained 145 patients who met the inclusion criteria and were divided into three subgroups.The control group(n=48)only received routine care.The positive psychological intervention group(n=48)and the cognitive behavioral intervention group(n=49)were respectively given routine care and positive psychological intervention and cognitive behavioral intervention program for 2 months.Before the intervention,on the day before discharge,and 8weeks after operation,three groups respectively used self-rating anxiety scale,self-rating depression scale,general well-being schedule and seattle angina questionnaire to evaluate anxiety,depression,subjective well-being and quality of life.At the same time,physiological indicators such as heart rate and blood pressure were recorded.The incidence of adverse cardiac events,length of stay and rehospitalization rate were also evaluated.The effectiveness and feasibility of positive psychological interventions and cognitive behavioral interventions for coronary interventional treatment were evaluated.Results1.The current state of anxiety,depression and subjective well-being in patients with coronary heart disease undergoing percutaneous coronary intervention(1)Anxiety and Depression:Among the 140 patients with coronary artery disease undergoing percutaneous coronary intervention,84(60%)patients suffering from anxiety,among which 72(51.43%)patients suffering from mild anxiety,12(8.57%)patients suffering from moderate anxiety;besides,for all the patients,34(22.86%)patients suffering from depression,among which 32(21.43%)patients suffering from mild depression,2(1.43%)patients suffering from moderate depression.The scores of anxiety were higher than the Chinese norm,while the scores of depression were lower than the Chinese norm,which showed there were significant differences(P<0.05).(2)Subjective well-being:Among 140 patients,the scores of subjective well-being were 69.29±8.34,which accounted for 75.71%of all patients,whose scores of subjective well-being lower than Chinese norm(male 75,females 71),and the scores of subjective well-being for both male and female patients were lower than the Chinese norm,respectively 73.33±6.43 and 65.15±8.32,and the differences were statistically significant(P<0.05).2.The major influential factors of anxiety,depression and subjective well-being in patients with coronary heart disease undergoing percutaneous coronary intervention(1)The main influential factors of anxiety in patients with coronary heart disease undergoing percutaneous coronary intervention were gender,average monthly income of family and subjective well-being scores:women(OR=5.958,95%CI:2.744~12.939),low household income(OR=0.012,95%CI:0.001~0.092)and patients with low scores of subjective well-being(OR=15.000,95%CI:6.431~34.989)were the risk factors of anxiety.(2)The main influential factors of depression in patients with coronary heart disease undergoing percutaneous coronary intervention were occupation and economic stress:farmers(OR=0.061,95%CI:0.030~0.126)and higher economic stress(OR=26.473,95%CI:9.964~70.336)were the risk factors of depression.(3)The main influential factors of subjective well-being in patients with coronary heart disease undergoing percutaneous coronary intervention were self-assessment of health and anxiety:poor self-assessment of health(OR=0.187,95%CI:0.074~0.475)and anxiety(OR=0.065,95%CI:0.016~0.258)were the risk factors of subjective well-being.3.The psychological intervention program for patients with coronary heart disease undergoing percutaneous coronary interventionThe program include positive psychological interventions and cognitive behavioral interventions.Positive psychological interventions include three good things,gratitude visit,you at your best,and fulfilling your life.Cognitive behavioral interventions include cognitive interventions,cognitive rehabilitation interventions,and behavioral interventions.4.The effects of the psychological intervention in patients with coronary heart disease undergoing percutaneous coronary intervention on anxiety,depression,subjective well-being,quality of life,heart rate and blood pressure indicators,length of hospitalization,cardiac adverse events and rehospitalization rates.(1)Effect on anxiety:Before the intervention,there was no statistically significant difference in the scores of anxiety among three groups(P>0.05);On the day before discharge,the scores of anxiety in cognitive behavioral intervention group and positive psychological intervention group reduce more significantly than those of the control group(P<0.05),there was no no significant difference between positive psychological intervention group and cognitive behavior intervention group(P>0.05);At 8 weeks after surgery,comparing with cognitive behavioral intervention group,the scores of anxiety in the positive psychological intervention group decreased more significantly,and the differences were statistically significant(P<0.05).(2)Effect on depression:Before intervention,there was no statistically significant difference in the scores of depression among three groups(P>0.05);After intervention:Comparing with the control group,the scores of depression in cognitive behavioral intervention group and positive psychological intervention group decreased more significantly,and the difference was statistically significant(P<0.05),but there was no significant difference between positive psychological intervention group and cognitive behavior intervention group(P>0.05).(3)Effect on subjective well-being:Before intervention,there was no statistically significant difference in the scores of subjective well-being between three groups(P>0.05);On the day before discharge:Comparing with two other groups,the scores of subjective well-being in positive psychological intervention group more obviously increase and the difference was statistically significant(P<0.001).At 8 weeks after surgery,the levels of subjective well-being in three groups were increased with varying degrees,and the positive psychological intervention group increased more significantly and the difference was statistically significant(P<0.001).(4)Effect on quality of life:There was no significant difference in the dimensions and scores of SAQ before intervention among three groups(P>0.05);after the intervention,all dimensions and scores of SAQ in three groups were higher than before.Comparing with the control group,except for the score of DP dimension,cognitive behavioral intervention group and positive psychological intervention group in the other scores of dimensions all increased significantly;but comparing cognitive behavioral intervention group with positive psychological intervention group,there was a statistically significant difference except for dimensions of AS(P<0.05).(5)Effect on indicators:After intervention,three groups of patients all had various degrees of improvement in their indicators.However,comparing with the control group,the levels of heart rate and blood pressure in the cognitive behavior intervention group and positive psychological intervention group improved more significantly than before,and the differences were statistically significant(P<0.05).There was no significant difference between cognitive behavioral intervention group and positive psychological intervention group(P>0.05).(6)Effect on hospitalization time,incidence of adverse cardiac events and rate of rehospitalization:Length of stay:there were statistically significant difference of three groups(F=3.884,P<0.05),but there was no significant difference between cognitive behavioral intervention group and positive psychological intervention group(P>0.05).The incidence of adverse cardiac events:on the day before discharge,there were no significant difference among three groups(?~2=0.530,P>0.05),and two cases in the control group,cognitive behavioral intervention group and positive psychological intervention group were one case respectively;At eight weeks after surgery,there were no significant difference among three groups(?~2=2.130,P>0.05),the incidence of adverse cardiac events increased in the control group,there were two cases of cognitive behavioral intervention group and one case of positive psychological intervention group.The rate of rehospitalization:there were no statistically significant difference of three groups(?~2=1.682,P>0.05).Conclusions1.The levels and prevalence rates of anxiety and depression are high,while the level of subjective well-being is low in patients with coronary heart disease undergoing percutaneous coronary intervention.2.There are various influential factors of anxiety,depression and subjective well-being in patients with coronary heart disease undergoing percutaneous coronary intervention,Among them,the main influential factors of anxiety in patients are gender,average monthly income of family and the scores of subjective well-being;the main influential factors of depression in patients are occupation and economic stress;the main factors of subjective well-being in patients are self-assessment of health and scores of anxiety.3.Both of positive psychological interventions and cognitive behavioral interventions can improve anxiety,depression,quality of life,heart rate,blood pressure,and reduce length of hospital stays in patients with coronary heart disease undergoing percutaneous coronary intervention.4.Comparing with cognitive behavioral interventions,the effectiveness of positive psychological interventions were more significant on anxiety,subjective well-being and quality of life in patients with coronary heart disease undergoing percutaneous coronary intervention. |
PDF Full Text Request