| BackgroundCoronary atherosclerotic heart disease(referred to as CHD) is one of the major diseases that threat to human health. The mortality caused by CHD has ranked the first among all diseases. In recent years, the incidence of CHD continued to rise in China, moreover, the age of onset is becoming younger. With the development and progress of medical sciences, percutaneous coronary stent implantation has gradually become one of the main techniques for the treatment of CHD. With the continuing efforts of scientists, stent implantation techniques and equipments have been significantly improved. The applications of stenting have significantly reduced the mortality of patients with CHD, but the high restenosis rate post stent implantation has not been completely solved. With the improvement of people’s living standards, importance has been attached to the quality of life after the disease. Mental disorders are very common in patients with CHD; and depression and anxiety disorders are most common, which affect the quality of life of patients; moreover, it is also one of the high-risk factors for cardiovascular adverse events. Depression and anxiety disorders can trigger and aggravate the body’s inflammatory response, elevate the level of inflammatory cytokines such as high sensitivity C-reactive protein(hs-CRP), etc. The hs-CRP is a recognized predictor of CHD, and also the most powerful predictor of major adverse cardiovascular events(MACE). After stent implantation, patients are more likely to suffer from depression and anxiety disorders, which reinforce and influence CHD in return, forming a vicious cycle, seriously affecting the prognosis and outcomes of the disease.Cognitive Behavioral Therapy(CBT) is a psychological therapy via interaction between doctors and patients, to allow patients to recognize their own cognitive bias, and actively correct the bad cognition, in order to achieve therapeutic purposes. CBT is mainly used for the treatment of depression and anxiety disorders. With the characteristics of short course, high efficiency, low recurrence rate, CBT has been extensively applied in the psychological therapies. There is a large group of young patients of post coronary stent implantation, and their depression and anxiety disorders have unique characteristics different from other populations. However, studies on the depression and anxiety disorders of young and middle-aged patients post coronary stent implantation are not reported home and abroad.In this study, we investigated the incidence of depression and anxiety disorders in young and middle-aged patients after coronary stent implantation, analyzed their characteristics, and further identified the factors that affected the morbidity of depression and anxiety disorders, and established the relationship between the depression and anxiety disorders and quality of life. Based on this, a cognitive behavioral intervention model suitable for young and middle-aged patients post coronary stent implantation was established. Finally, validation on the established cognitive behavioral intervention model was performed, to provide theoretical and practical basis for the treatment of young and middle-aged patients with depression and anxiety disorders after coronary stent implantation.Objection1. To describe the prevalence of depression and anxiety disorders of young and middle-aged patients with CHD post coronary stent implantation and its influencing factors.2. To understand the relationship between the depression and anxiety disorders and quality of life of young and middle-aged patients with CHD post coronary stent implantation.3. To construct a cognitive behavioral intervention therapy mode for depression and anxiety disorders of young and middle-aged patients with CHD post coronary stent implantation.4. To know whether the quality of life of young and middle-aged patients with CHD with depression and anxiety disorders post coronary stent implantation is improved through cognitive behavioral intervention therapy.5. Identify the influence of cognitive behavioral intervention therapy on related biochemical indexes of young and middle-aged patients with CHD with depression and anxiety disorders post coronary stent implantation.6. Identify whether the cognitive behavioral intervention therapy can reduce the incidence of MACE for young and middle-aged patients with depression and anxiety disorders post coronary stent implantation.Methods1. Rating scale measurement was performed for 168 young and middle-aged patients post coronary stent implantation in Department of Cardiology, Southwest Hospital, to understand the incidence of depression and anxiety disorders, quality of life, coping mode and social support of young and middle-aged patients with CHD with stent implantation. Through the factor analysis and regression analysis, etc, the characteristics of the depression and anxiety disorders for young and middle-aged patients with CHD with stent implantation and its influencing factors were identified.2. According to the characteristics of the depression and anxiety disorders for young and middle-aged patients post coronary stent implantation and its influencing factors and based on the professional knowledge of cardiology and the cognitive behavioral intervention theory, the cognitive behavioral intervention system was constructed.3. 89 patients with depression and anxiety disorders post coronary stent implantation, as the research subjects, were divided into experimental group and control group. After consultation of physicians from clinical psychology, the patients were given antidepressants and anti-anxiety drugs. The patients in the experimental group underwent cognitive behavioral intervention, 40-60 min each time, once about two weeks, and 6 times in total. The quality of life, one-year incidence of MACE, hs-CRP, liver function, blood lipids and other indices were measured before and after the experiments, to validate the effect of cognitive behavioral intervention model.Results1. The incidence of depression and anxiety disorders for young and middle-aged patients post coronary stent implantation was as high as 52.98%, of which, the incidences of concurrent depression, severe depression, moderate depression and mild depression were 41.67%, 2.38%, 7.74% and 35.12% respectively; and the incidences of concurrent anxiety disorders was 37.50%, of which, the incidences of severe anxiety disorders, moderate anxiety disorders and mild anxiety disorders were 2.98%, 5.95% and 28.57% 5 respectively. The incidence of depression with anxiety disorders was 26.19%.2. The depression and anxiety disorders for young and middle-aged patients post coronary stent implantation showed the following characteristics: the SDS score of farmers and rural health care groups was higher than that of other groups(F=5.917,P<0.01;T=3.396,P<0.01); the populations with primary school education had a higher proportion of severe depression and depression with anxiety(X2=4.712,P<0.05); the low income groups had a higher proportion of severe depression(P<0.05); the patients concurrent with hypertension and diabetes had a higher proportion of depression and anxiety disorders(X2=4.034,P<0.05;X2=16.842,P<0.01;X2=10.476,P<0.01;X2=16.860,P<0.01); the patients with small age, acute myocardial infarction and complicated diseases with more stents had a higher proportion of severe anxiety disorders(X2=8.949,P<0.01;P<0.01;X2=6.456,P<0.01).3. The subjective support, utilization of support, coping way and education level were the direct influencing factors of depressions for young and middle-aged patients post coronary stent implantation; while the giving up, avoidance coping, utilization of support and combined with hypertension were the direct influencing factors of anxiety disorders for young and middle-aged patients post coronary stent implantation.4. Compared with the control group, the quality of life of patients in the cognitive behavioral intervention group was significantly improved and the hs-CRP level, Triglyceride(TG), Low Density Lipoprotein Cholesterol(LDL-C) levels in blood lipids were significantly decreased, showing statistically significant difference between them(P<0.01).The incidence of MACE in the experimental group showed a declining trend.Conclusion1. The overall incidence of depression and anxiety disorders for young and middle-aged patients post coronary stent implantation is slightly higher. The clinical staff should pay more attention to the patients of farmers, lower education level, poor health care in rural areas and patients with chronic diseases such as hypertension and diabetes. Psychological counseling should be given to patients with younger age, acute myocardial infarction, complicated diseases with more stents, to reduce the incidence of postoperative depression and anxiety disorders.2. Social support and coping way have very important impact on the young and middle-aged patients with depression and anxiety disorders post coronary stent implantation. The development of cognitive behavioral intervention strategies should consider the relevant aspects, to make the behavioral intervention strategies more scientific and reasonable.3. Through the cognitive behavioral intervention therapy, the depression and anxiety disorders of young and middle-aged patients post coronary stent implantation can be significantly alleviated, and their quality of life can be significantly improved, showing a good clinically practical significance.4. After cognitive behavioral intervention, the relevant biochemical indices of young and middle-aged patients with depression and anxiety disorders post coronary stent implantation were decreased significantly compared with the control group. The incidence of MACE in the experimental group showed a declining trend. |
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