A Longitudinal Study On The Stress Perception And Stress Response Of Patients With Acute Myocardial Infarction

Background:Acute myocardial infarction(AMI) is a serious coronary heart disease, and it has posed a health threat to people in our country. The incidence of AMI in china has been increasing these years. The onset of AMI is usually unexpected, and at the acute phase, the patients are in a very serious condition and the illness condition changes quickly. After discharging from the hospital, the patients' lifestyle and living conditions may experience significant changes. When facing with the stressors coming from the disease,environment of the hospital, or the family and society, the patients may have different stress perceptions. Some studys showed that patients with AMI had various digrees of pressure during the rehabilitation process.In our country, there are no study investigating the change of the patients'stress perception and stress response longitudinally. This study used the theory-"interaction of cognitive and stress" as the framework, and especially considered the regulating function of coping styles and social support on patients'psychological health, conducted a longitudinal study using the qulitative method combined with the quantitative evaluation to explore the stress perception and stress response of patients with AMI.Objective:(1) To investigate the level of stress perception and its the changing trend in patients with acute myocardial infarction (AMI) during their rehabilitation process;(2)To investigate the stress response status and its changing trend in patients with AMI during their rehabilitation process;(3) To identify the coping style and the social support in patients with AMI in four periods; (4) To analyze the influential factors of stress perception and stress response status of patients with AMI in four periods during their rehabilitation process; (5) To explore the stress experiences of patients with AMI during the first 6 months after the onset of the disease.Methods:This study includes two parts:the Longitudinal survey and the qualitative study using the phenomenology method.In the Longitudinal survey study,60 AMI patients from the cardiology department of Zhongshan hospital and Huashan hospital, were investigated during the first 6 months in their rehabilitation process from January 2010 to September 2010. The Common status Questionnaire, The Chinese Perceived Stress Scale(CPSS),The Hospital Anxiety and Depression Scale(HADS), the Social Support Scale(SSS) and the Medical Coping Modes Questionnaire(MCMQ) were used respectively to investigate the common status, stress perception, psychological stress responses, social support conditions and coping styles of patients with AMI. The survey were conducted in four different times:7～10 days (time 1),6 weeks (time 2),3 months (time 3) and 6 months (time 4) after the onset of AMI. The SPSS15.0 was used for data analysis.In the qualitative study, the phenomenology method was adopted,15 patients with AMI participated in the semi-structure interviews which were conducted in four times:7～10 days, six weeks, three months and six months after the discharge. The data was analyzed by Claizzi's phenomenological procedure.Results:In the Longitudinal survey study:(1) The scores of CPSS scale in four times were 19.45±5.96,17.67±6.33,14.75±6.41,15.25±6.32, The repeated measure analysis of variance indicated that the level of stress perceptions were different along with the change of time (P< 0.05).The percentages of patients with stress threating to health in the four times were:20%,15%,8.3%,8.3%. The chi-square test indicated that the difference between these four percentages was significant (P <0.05). (2)The scores of anxiety in the four times were:6.80±2.57,5.88±2.15,5.08±2.55及4.82±2.49. The repeated measure analysis of variance indicated that there were significant difference between the scores of anxiety in four time points (P<0.05). The scores of depression in the four times were:5.52±3.66,4.67±3.81,4.23±3.55,4.03±2.86. The repeated measure analysis of variance indicated that there were significant difference between the scores of anxiety in four time points(P<0.05). The incidence of anxiety in the four times were:33.3%,20%,10%,11.7%, which were significantly different (P<0.05). The incidence of depression in the four times were:33.3%,20%,23.3%,11.3%, which had significant difference (P<0.05). (3) Comparing the average scores of the confrontation coping style to the norm, except the scores measured in the 6th week, the other scores were significantly lower than the norm(P<0.05). Comparing the average scores of the avoidance coping style to the norm, except the scores measured in the 6th month, the other scores were significantly higher than the norm(P<0.05). Comparing the average scores of the resignation coping style to the norm, only the score of resignation coping style measured in hospital was significantly higher than the common model (P<0.05). The repeated measure analysis of variance showed that:At different time points, the difference of the scores of confrontation coping style had no statistics significance(P >0.05), and the difference of the scores of avoidance coping style had no statistics significance(P> 0.05), but the scores of resignation coping style significance were significant different (P<0.05). (4) The whole social support scores in four time points were all higher than the common model (P<0.05). The scores of active support, objective support, utilization of support and the whole score of support had no significant change along with time(P>0.05). (5) The stepwise regression analysis showed that:during 7～10 days after the onset of AMI, the level of stress perception was influenced by resignation coping, smoking state in the past, confrontation coping, occupation and living status;the level of cardiac function may influence the incidence of anxiety; the whole score of social support and the resignation coping might influence the incidence of depression. On the time of six weeks after the onset of AMI, the level of stress perception was influenced by resignation coping,exercising status in the past, age and the whole score of social support;the resignation coping, age and exercising status in the past might influence the incidence of anxiety; the resignation coping, age, exercising status in the past and confrontation coping might influence the incidence of depression. On the time of three months after the onset of AMI, the level of stress perception and the incidence of anxiety and depression were influenced by resignation coping;the passive support, occupation and avoidance coping may influence the incidence of depression. On the time of six months after the onset of AMI, the level of stress perception was influenced by resignation coping, exercising status and the level of cardiac function;the resignation coping, exercising status and passive support might influence the incidence of anxiety; the resignation coping and the avoidance coping mmight influence the incidence of depression.In the qualitative study:the stress response of patients at the early stage of AMI included three aspects:①facing the strike of reality;②the changing role;③preparation of going back to normal life and rebuilding. The stress response of patients with AMI when they leave hospital included three aspects:①worrying about the rehabilitation ofAMI;②changing the living habits;③rebuilding the interpersonal relationships.Conclusions:(1) The stress perception was most significant when patients were in hospital, although the level of stress perception decreased after they discharged, patients still had some stress in life. (2) According to the semi-structure interviews, patients in hospital felt stressful during the process of facing the strike of reality, changing the role and preparing for going back to normal life and rebuilding. When patients left hospital after they discharged, they felt stressful during the process of worrying about the rehabilitation, changing the living habits and rebuilding the interpersonal relationships. (3)The patients with AMI preferred to use the avoidance coping style during the rehabilitation process, and they used the confrontation coping style less frequently than the norm. (4) AMI patients should choose different coping strategies according to different phases during the disease rehabilitation. (5)The social support could decrease AMI patients' psychological stress. (6)Healthy life habits could decrease AMI patients' psychological stress. (7) Patients were worrying about whether they could go back to work again after the onset of AMI.