Psychosocial Aspects of Heart Disease

Question 1

How are psychosocial factors related to heart disease?

Answer 1

Socio-demographic factors - influence risk and accessibility to health care services
Lifestyle factors
Triggering cardiac events
Personal beliefs can influence our use of medical care.

Question 2

What are some acute and chronic pyschosocial risk factors for heart disease?

Answer 2

Socio-economic status
Lifestyle
Stress and strain
Hostility/anger
Social isolation
Depression and anxiety.

Question 3

What are some of the social determinants of heart disease?

Answer 3

Sociopolitical and economic context in which people live
This can include neighbourhood environment (built and natural)
Socioeconomic status - occupation, income
Access and quality to education and healthcare.
Structural racism and discrimination.
Social risk - food insecurity, housing instability, financial strian
Lived experiences - bias, discrimination, health literacy.

Question 4

What are some of the linking factors between coronary heart disease and socio-economic disadvantage?

Answer 4

Patterns of smoking and diet as cultural normality or fulfillment of identity
Stressful work experience - level of demand and control over jobs
Income and social status
Social support networks
Education
Physical environment
Personal health practises and coping skill
Healthy child development
Health services and availability.

Question 5

What are the three A needed to ensure intervention in coronary artery disease prevention?

Answer 5

Ensuring health care and good health is available, accessible and affordable.

Question 6

How does lived personal experience link to risk of coronary artery disease?
What interventions can target this?

Answer 6

Lived personal experience includes everyday discrimination and stigma, neighbourhood perception, health literacy, implicit bias, social needs and perceived health status
We can improve these factors by health/lifestyle coaching, medication management, patient education, patient navigation and case management.

Question 7

How does social and community context link to risk of CHD?
What interventions can target this?

Answer 7

Risks include - food environment, socia envrionment and cohesion
Social - transportation instability, financial strain, food insecurity, housing instability.
We can improve these factors through - community based organisations, quality housing, education programmes, bottom up intervention schemes.

Question 8

How does sociopolitical and economic context link to risk of CHD?
What intervention can we use to target this?

Answer 8

Risks include economic stability, education access and quality, neighbourhood and built environment, health care access and quality, structural discrimination and racism.
Interventions include - improved health insurance, education, poverty interventions, urban planning and community investment.

Question 9

What is the link between gender and CHD?

Answer 9

CHD - major cause of death in males and females
Once considered a male disease
Typically develops 7-10 yrs later in female
Female rates underestimated due to poor awareness - misconception unlikely, this leads to later intervention, less involvement of women in clinical trials and less aggressive treatment methods
This gender gaps means women often assume symptoms are due to something else.

Question 10

What are the big five personality traits?

Answer 10

Extraversion
Conscientiousness
Openness
Neuroticism
Agreeableness

Question 11

Explain the relationship between personality traits and health outcomes.

Answer 11

Personality predispose to physiological changes e.g increased stress may increase HR.
Tropisms of certain personalities imply personality traits can make an individual more likely to respond to risks in certain ways or adopt certain behaviours
Personaility can influence health beliefs influence help seeking and health prioritisation
Personaility influence the stress process, how they cope with this and the physiological response of the body to stress.

Question 12

What are the four different psychology models that link personality to cardiovascular disorders?

Answer 12

Personality induced hyperactivity model
Dangerous behaviour model
Transactional stress moderation model
Constitutional predisposition model

Question 13

What is the personality induced hyperactivity model link between personality and CHD?

Answer 13

Individual personality may be a style of functioning biologically.
Exaggerated neuroendocrine and SANA response towards perceived stressors.
Percieved stimuli as more threatening so more intense response
Tend to be Type A personality with high noradrenaline levels, blood clotting times, cholesterol levels etc

Question 14

How does the dangerous behaviours model link CHD and personality?

Answer 14

Personality to affect health promoting or health degrading behaviours.
May underreport severity of symptoms
Type A - seek more challenging and competitive situations, smoke and consume more alcohol.

Question 15

How does the transactional stress model link CHD and personality?

Answer 15

Certain personalities are predisposed to cope in certain ways.
This can cause adverse physiological and behaviour consequences
Type A personalities tend to be emotion-focused and avoidance-focused coping.

Question 16

How does the constitutional predisposition model link personality and CHD?

Answer 16

Biological intercation
Noncausal association between personality and health due to underlying genetic.

Question 17

What is Type A behaviour and how does this tend to influence health?

Answer 17

Tend to be motivated, competitive and with high levels of self control. Achievement focused in terms of self worth, with a tendency to be highly critical of themselves.
Very time focused.
Can be aggressive and hostile due to high stress lifestyle.
This means they tend to follow poor health behaviours such as smoking or alcohol as a coping mechanism.
They can deny/ignore symptoms to not appear weak.
Increased risk for depression and exhaustion
Tendency for acute stress
Some link to heart disease but uncertain how far.

Question 18

How does hostility link to CHD?

Answer 18

Increase risk of CHD
Reduces social support, increase SANS - increase strain and workload on heart
Particularly high in unexpressed anger.

Question 19

What is a type D personality?

Answer 19

Distressed personality - high levels of negative emotions as pessimistic with a lack of self esteem, they conceal emotions in social situations (social inhibition)
Is a risk for cardiovascular disease, tend to die earlier forms stroke or heart disease,
Have highly activated immune systems and more inflammation (damage blood vessels)
Greater increase in blood pressure due to stress
Engage in fewer health-promoting behaviours and lower levels of social support.

Question 20

What is the link between stress and heart disease?

Answer 20

Chronic high levels of stress can increase cardiovascular reactivity
Can cause hypertension
The cumulative burden (allostatic load) of chronic stress can increase risk of recurrent MI by gradually predisposing the blood vessels to injury.

Question 21

What are the different types of evidence supporting the link between stress and CHD?

Answer 21

Epidemiological studies - prospective
Clinical studues -retrospective on patients with atherosclerosis
Labortoary studies with controlled variables linksing stressors and physiological responses.

Question 22

What psychological and behaviour responses increase a patients risk of/from CHD?

Answer 22

Misinterpret symtposm
Many patients have non-cardiac chest pain from anxiety about physical symptoms.
Do no recognise symptoms and delay help seeking
Anxiety and depression
A slower response can prevent early revascularization as a management leading to poorer patient outcomes.

Question 23

What does the self regulatory model teach is the behavioural response to heart disease?

Answer 23

Symptom perception influences our emotions and cognitions (illness representation). These also influence each other.
Weh must then cope with our emotions and illness threat
We then appraise how well we coped, this influenced our perception of how the illness affected us.

Question 24

How do our congitive responses influence our recovery from CHD?

Answer 24

Behaviour is strongly linked to beliefs
Controllability and durability of illness - links strongly to attendece ar rehabilitation
Believing there are less consequences encourages quicker return to work leading to a better socio-economic recovery.

Question 25

How do our emotional responses to CHD influence our recovery and health?

Answer 25

Anxiety towards symptoms is often confused with CVD
Some patients develop PTSD as worried about cardiac health, this further increases the risk of MI recurrence.
Anxiety is high during admission, investigations/treatment, discharge and one year afterwards, but peaks during treatment. Does not decrease in patients after leaving hospital.

Question 26

What are the potential sources of anxiety in patients who have had an MI?

Answer 26

Investigations such as cardiac catheterization
Discharge
Fear of over-exertion
Over-protection leads to cardiac invalidism (remain in sick role despite near or complete physical recovery)
Family members anxiety at time of event can reflect onto the patient.

Question 27

What is the link between depression and CHD?

Answer 27

Can be co-morbid with anxiety
Flattened response to all situations, negative thoughts, reduced activity and perceived lack of control
Is more likely in young, female and isolated patients
Is independent from severity of MI
Increases the risk of a 2nd MI
Should be screened for with 30% being depressed during hospitalisation and 20% remaining depressed after discharge.

Question 28

What are the recommendations of screening for depression in someone with an MI?

Answer 28

NICE recommend - during last month feeling down, depressed or hopeless? During last month - bothered by having little interest or pleasure in doing things? if answer yes to either question is positive indicator for depresssion.
Should then follow assessment tool validated for use in primary care by NICE QOF to assess severity of depression.

Question 29

What are the implications of depression and anxiety on behaviour related to patients with CHD?

Answer 29

Delay in returning to work
Low rating of social satisfaction
Reduction in sexual activity - impact on relationships and self confidence
Poorer adherence but more likely to attend doctors with general worries
Negative impact on lifestyle and quality of life.

Question 30

How does depression affect prognosis with CHD?

Answer 30

Bio - HPA axis dysfunction, reduced HR, inc Inflammatory response, impaired vascular function (inc platelet adhesion and aggregation)
Behavioural - poor adherence to medication and lack of participation in cardiac rehab
Lifestyle - smoking, diet, sedentary
Psychosocial - social isolation, chronic stress, co-moribd anxiety disorders.

Question 31

What are the potential positive health changes after an MI?

Answer 31

Encourages patients to make healthy lifestyle changes.
However, diet and smoking changes tend to by short term. Most patients return to normal behaviour within 1 year.
Increases appreciation of life and improved close relationships

Question 32

What is the use of psychology in the management of heart disease?

Answer 32

Cardiac rehabilitation - aims to help the patient recover as quickly and completely as possible.
This should include psychy to increase confidence around exercise, anxiety and depression reduction.
THis would provide more holistic care for the patient.

Question 33

What are the psychological objectives of cardiac rehabilitation?

Answer 33

Modify behavioural risk factors: lifestyle, Reduce Type A behaviour and stress
Improve psychological functioning -
Improve quality of life.
Reduce patient and family nerves around exercise
Improve self efficacy by routine testing and rehabilitation sports classes - encourages long term adoption of behaviour.

Question 34

What is the purpose of comprehensive cardiac rehabilitation?

Answer 34

Reduce psychological distress for patients and their families
Improve cardiovascular fitness
Reduce mortality and hospital readmissions
Increase rate or return to paid employment
Reduce health service costs
Should be individualised to patient needs and offer a wide range of treatments
Can reduce mortality by 20-25% over 3 years.

Question 35

Why is it difficult to evaluate how effective cardiac rehabilitation is?

Answer 35

Many different programmes used that focus on different outcomes such as mortality or return to work etc
Many different ideas of success - pysch, bio, eco
Confounding variables such as sex, age and socio-economic status between patients

Question 36

What is the usefulness of long-term cardiac rehabilitation aka after 12 months?

Answer 36

-Differences between patient psychosocial and physical health declines (not as much benefit to be gained)
-Many patients stop attending when they feel better
+ longer programmes would help reinforce behavioural changes
+ is recommended in NICE guidelines.