Role of different determinants of psychological distress in acute coronary syndromes

J Am Coll Cardiol. 1998 Sep;32(3):613-9. doi: 10.1016/s0735-1097(98)00282-4.


Objectives: The aim of this study was to examine the prevalence of psychological distress and of its major determinants in acute coronary patients and in a control group.

Background: The prevalence and major determinants of psychological distress in acute coronary patients are not clear.

Methods: One hundred and thirty cardiac patients (110 men, age 56+/-9; 85 with acute myocardial infarction and 45 with unstable angina) and 102 controls hospitalized for acute trauma (70 men, age 55+/-9 years) were studied and the level of psychological distress estimated by a Modified Maastricht Questionnaire, self-ratings and ratings by a close relative. Major determinants of psychological distress were assessed by the Life Events Assessment, the Social Support Questionnaire and the Ways of Coping Checklist.

Results: The average level of psychological distress was significantly higher (p < 0.001) in coronary patients than in controls in all tests (self-evaluation=7.1+/-2.3 vs 4.3+/-2.4; relative-evaluation = 7.4+/-2.4 vs 4.2+/- 2.5; Modified Maastricht Questionnaire=91+/-32 vs 59+/-30). Cardiac patients reported significantly higher (p < 0.05) levels of social isolation (28.9+/-11.1 vs 23.4+/-8.8), self-blame (7.2+/-1.9 vs 5.8+/- 1.6) and avoidance (21.1+/-3.5 vs 18.9+/-3) and more painful life events (3.9+/-3.8 vs 2.6+/-2.2), than controls. However, not all patients had evidence of distress; indeed, cluster analysis identified a subgroup that comprised 75% of controls and 25% of cardiac patients with no determinants eliciting distress, while the other four subgroups, with one or more determinants of distress, comprised about 75% of patients and only 25% of controls.

Conclusions: These results show that a high level of psychological distress is detectable in about 75% of patients with acute myocardial infarction or unstable angina and is related to one or more major determinants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Aged
  • Angina, Unstable / psychology*
  • Defense Mechanisms
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / psychology*
  • Personality Inventory
  • Risk Factors
  • Sick Role*
  • Stress, Psychological / complications*