Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Psychological distress in coronary heart disease: Risk indicators, treatment and cardiovascular prognosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0001-8895-5247
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to: (1) explore factors associated with emotional distress; (2) investigate psychosocial stress as a risk factor for cardiovascular (CV) morbidity in patients with coronary heart disease (CHD); (3) investigate the impact of group-based stress management on psychological outcomes, and if that mediates risk of CV events; and (4) evaluate an internet-based cognitive behavioral therapy (iCBT) for emotional distress in patients with a recent myocardial infarction (MI).

In Study I, data from the national registry SWEDEHEART on 27,267 MI patients < 75 years was used. Study II was a prospective longitudinal study with 14,577 patients with stable CHD. Psychosocial stress was assessed with a questionnaire and patients were followed-up for clinical events on average 3.7 years. In Study III, a group-based stress management was evaluated in a randomized controlled trial of 362 CHD patients. Psychological outcomes (stress, somatic anxiety, depression and vital exhaustion) were assessed at five time-points over two years. Joint modelling for longitudinal and time-to-event data was used to analyze if reduction in the psychological outcomes mediated the positive effect the treatment had on later CV events. Study IV describes Study V and includes a pilot study investigating the acceptability of the intervention used. In Study V 239 MI patients were recruited to evaluate iCBT versus usual care in a randomized clinical trial.

In summary, in Study I, sociodemographic factors, previous psychiatric diagnosis and readmission for CV events were associated with incident and persistent emotional distress post-MI. In Study II, after multivariable adjustments, depressive symptoms, financial stress and living alone were all independently associated with CV death or the composite of CV death, non-fatal MI or non-fatal stroke. These results emphasize the importance of targeting psychosocial factors in order to optimize secondary prevention. In Study III, somatic anxiety was the only targeted psychological outcome affected positively by stress management, and may have in turn reduced subsequent CV events. Other mediating factors remain to be identified. Study IV indicated the intervention used in Study V was acceptable. Study V concluded that iCBT was not superior to usual care for emotional distress in post-MI patients and treatment adherence was unexpectedly low. Potential reasons for the low adherence require further exploration.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. , p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1412
Keyword [en]
psychological distress, myocardial infarction, coronary heart disease, depression, anxiety, stress, cognitive behavioral therapy, iCBT, stress management, cardiac rehabilitation
National Category
Cardiac and Cardiovascular Systems Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-336234ISBN: 978-91-513-0192-1 (print)OAI: oai:DiVA.org:uu-336234DiVA: diva2:1165825
Public defence
2018-02-14, Sal IV, Gamla universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 2009–1093
Available from: 2018-01-24 Created: 2017-12-13 Last updated: 2018-01-25
List of papers
1. Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry.
Open this publication in new window or tab >>Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry.
Show others...
(English)In: Article in journal (Refereed) Submitted
National Category
Psychology Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-336226 (URN)
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2017-12-13
2. Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Open this publication in new window or tab >>Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Show others...
2018 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 1, p. 83-92Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Assess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD).

METHODS: Psychosocial stress was assessed by a questionnaire in 14 577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomized STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes.

RESULTS: After 3.7 years of follow-up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09-1.34; 1.15, 1.05-1.27; and 1.19, 1.08-1.30, respectively) and the primary composite end-point of CV death, nonfatal MI or nonfatal stroke (1.21, 1.13-1.30; 1.19, 1.11-1.27; and 1.17, 1.10-1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38-2.05) and the primary composite end-point (1.28, 1.11-1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49-0.82) and the primary composite end-point (0.81, 0.67-0.97).

CONCLUSIONS: Psychosocial stress, such as depressive symptoms, loss of interest, living alone and financial stress, were associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.

Keyword
death, depression, psychosocial stress, stable coronary heart disease
National Category
Cardiac and Cardiovascular Systems Psychology
Identifiers
urn:nbn:se:uu:diva-333087 (URN)10.1111/joim.12692 (DOI)000418411100006 ()28960596 (PubMedID)
Funder
GlaxoSmithKline (GSK)
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2018-01-29Bibliographically approved
3. Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
Open this publication in new window or tab >>Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
Show others...
2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, p. 917-925Article in journal (Refereed) Published
Abstract [en]

Background:The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlledtrial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heartdisease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aimof this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vitalexhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events.

Methods:A total of 362 patients were randomly assigned to intervention or usual care groups. The psychologicaloutcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of theoutcomes were analysed using joint modelling of the longitudinal and time to event data.

Results:The intervention had a positive effect on somatic anxiety (p<0.05), reflecting a beneficial development overtime compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time.Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events.

Conclusions:The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustionor depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardio-vascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, themechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

Keyword
Stress management, cognitive behavioural therapy, coronary heart disease, depression, anxiety, vital exhaustion
National Category
Psychology Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-315597 (URN)10.1177/2047487317693131 (DOI)000401147700004 ()28195501 (PubMedID)
Conference
International Society of Behavioral Medicine, Groningen 2014
Funder
Vårdal FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish National Board of Health and WelfareSwedish Research Council
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2017-12-20Bibliographically approved
4. Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial
Open this publication in new window or tab >>Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial
Show others...
2015 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 16, article id 154Article in journal (Refereed) Published
Abstract [en]

Background: Major depression and depressive symptoms are common in patients with a recent myocardial infarction (MI), and depression is associated with adverse cardiovascular outcomes. Anxiety post-MI is less studied, but occurs commonly in patients with heart disease, and is also considered a risk factor for recurrence of cardiac events. Cognitive behavior therapy (CBT) is an established therapy for depression and anxiety disorders. To the best of our knowledge, there have not been any studies to determine if internet-based CBT (iCBT) can reduce the symptoms of depression and anxiety in patients with a recent MI. The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI. Methods/design: This is a randomized, controlled, prospective study with a multicenter design. A total of 500 participants will be randomized at a 1:1 ratio, around two months after an acute MI, to either iCBT or to a control group. Both groups will receive an optimal standard of care according to guidelines. The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist. Treatment duration is 14 weeks. The primary outcome is change in patients' self-rated anxiety and depression symptoms from baseline to end of treatment. An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment. Discussion: The present study is designed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population. If effective, iCBT has several advantages, and will potentially be implemented as an easily accessible treatment option added to modern standard of care.

Keyword
Myocardial infarction, CBT, iCBT, Anxiety, Depression, Internet, U-CARE
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-252686 (URN)10.1186/s13063-015-0689-y (DOI)000353018100001 ()25873137 (PubMedID)
Funder
Swedish Research Council, 2009-1093
Available from: 2015-05-25 Created: 2015-05-11 Last updated: 2017-12-13Bibliographically approved
5. Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
Open this publication in new window or tab >>Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
Show others...
(English)In: Article in journal (Refereed) Submitted
National Category
Psychology Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-336209 (URN)
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2017-12-13

Open Access in DiVA

fulltext(1087 kB)85 downloads
File information
File name FULLTEXT01.pdfFile size 1087 kBChecksum SHA-512
615cbdd951d36c4490e1a39eac8f1c7ff1284ef1f350bf06de3a96a8a0262a01a59b7741ae3e1b5da2cff2ee5e879ce4f979b463fcb5eaf286cb171f4da58db3
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Norlund, Fredrika
By organisation
Clinical Psychology in Healthcare
Cardiac and Cardiovascular SystemsPsychology

Search outside of DiVA

GoogleGoogle Scholar
Total: 85 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2448 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf