Psychosocial heart disease Flashcards
How are psychosocial factors related to heart disease?
Socio-demographic factors associated with risk and accessibility of health care services
Lifestyle factors
Triggering cardiac events
Beliefs influencing use of medical care
What are the psychological risk factors for heart disease?
- Socio-economic status
- Lifestyle
- Stress and strain
- Hostility/anger
- Social isolation
- Depression and anxiety
- These factors overlap
what is Type A Behaviour what is the link to heart disease
- Widely tested for risk factor heart disease
- Measured by self-report questionnaire or structured interview
- negative attitudinal set, antagonistic style and negative expectations”
- Greater physiological reactivity to stressors (increased BP, adrenaline, noradrenaline and cortisol)
- Anger can trigger MI
- Greater likelihood of encountering stress
- Hostility also reduces social support
link between stress and heart disease
the stress respose pathway has 2 components, what are they:
sympathetic axis- acute route
hypothalamic-pituitary axis- chronic route
list the sympathetic response to stress
- Stressor
- Hypothalamus
- ANS-SNS
- Adrenal glands- medulla
- Adrenaline and noradrenaline
- Increased heart rate
- Arrhythmia
hypothalamic-pituitary acis- chronic stress pathway
Hypothalamus (CRH)
Pituitary gland (ACTH)
Adrenal glands- cortex (cortisol)
Increased BP, changes in clotting process
allostatic load
”- physiological toll of repeatedly adapting to chronic stressors- the effects are cumulative
Chronically high levels of stress may increase CV reactivity
reactivity is related to family history, physical fitness and support
hyper-reactivity is not associated with the development of heart disease in heealthy populations
But … hyper-reactivity is associated with the development of hypertension– big risk factor for further CV events
What are the people’s response to having heart disease?
model for experincing any disease: psychological,social factors and underlying pathology affect people’se experience of illness
regulatory model of illness behaviour model
we interperate the health threat (perceiving the sympotms and then interperating our emotions and cognitions) we then engage in coping behaviour with the illness threat and the emotions they cause) we then finish by appraising our situation
how do cognitive responses affect how we inetract with illness
controlllabilty and curability of illness directly related to rates of attending rehab and that less serious consequences meant a quicker return to work and better social functioning.
what are 2 common emotional responses to being diagnosed w a disease?
anxiety
depression
anxiety
“A feeling of apprehension accompanied by negative thoughts (worry) and physical (somatic) symptoms”
Physical symptoms of heart disease overlap with those of anxiety, easily mixed up (75% of people with MI worry about their cardiac state)
16% of MI patients develop PTSD
No way of knowing who will be affected
biphasic response initially, low anxiety at first which rises and then decreases upon discharge
HADS
Psychometric scale that measures anxiety and depression
Score of ~8/21 or higher indicates anxiety
Sources of anxiety in medicine
Investigations (cardiac catheterization)
Discharge
Concern of mortality
Fear of over-exertion
Family’s fears (over-protective, leads to cardiac “invalidism”
depression and heart disease
implications of anxiety and depression for behaviour
Delay in returning to work
Low ratings 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
positive consequences of MI
Many report healthy lifestyle changes
Some have a greater appreciation for life
Improved close relations
these things can however be short term
can psychology play a apart in the management of heart disease?
yes- cardiac rehab
definition of rehabilitation
“the sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they may, by their own efforts, preserve (or resume when lost) as normal a place in society as possible”
Psychological objectives of cardiac rehab
Modify behavioural risk factors:
- lifestyle factors, e.g. unhealthy diet, smoking, lack of exercise
- type A behaviour
- stress
(involves assessment, education and provision of opportunities)
- Improve psychological functioning
- Improve QoL
gives you a locus of control
comprehensive cardiac rehab should have
Should have multi-components: menu of treatments
Wide access to all patients
Individualised/ targeted; this helps to increase adherence
Can reduce mortality
what are the predicted benefits of cardiac rehab
Positive effects on prognosis, e.g. prevention of future complications
Improvements to psychological and social well-being, including economic costs to the individual, their family and society
Financial cost benefit to health service providers, because if rehab is “effective” then patients will need less future health care
Taking up cardiac rehab is patchy and adherence is sometimes poor
evidence base for cardiac rehab
Difficult to evaluate
There are different rehab “packages”
Different outcome measures are used (e.g. mortality, rate of return to work)
Confounding variables (e.g. gender, age, socio-economic)
Varying length of follow up
long term benefits of cardiac rehab
Differences in psychosocial benefits decline
Physical benefits decline- mainly because people drop out (risk of death seems less)
Some patients prefer home based programmes
Probably cost effective and QoL is improved
