Psychosocial Aspects of Heart Disease

• What are the psychosocial risk factors of heart disease?

  Socio-economic status

  Lifestyle

  Stress & strain

  Hostility/anger

  Social isolation

  Depression & anxiety
• What are the social determinants of heart disease?

  Socioeconomic disadvantage

  • smoking
  • diet
  • stressful work experience
  • income & social status
  • social support networks
  • education
  • employment & working conditions
  • physical environments
  • personal health practice & coping skills
  • health services
• What are the 5 broad personality traits (The Big Five)?

  Conscientiousness

  Extraversion

  Agreeableness

  Neuroticism

  Openness
• Define personality traits.

  Stable individual differences in thinking, feeling & behaving across a range of different situations
• What is the relationship between personality traits & health outcomes?

  Personality traits can impact;

  • physiological changes
  • tropisms (risky situations/behaviours)
  • health behaviours (engagement in health-related behaviours)
  • stress processes (coping mechanisms/social support)
• What is Type A behaviour behaviour? What is it related to?

  A blend of traits

  Negative health behaviours/risk taking

  Ignore/deny symptoms

  Frustrated attempts to control events -> can lead to depression & exhaustion

  Behaviour can lead to acute stress

  Identified as a RF for CVD in 1950s
• How does hostility & anger impact CVD risk?

  Hostility

  • greater physiological reactivity to stressors -> increase BP, adrenaline & cortisol
  • also reduces social support

  Anger

  • higher anger -> higher incidence of CVD (particularly unexpressed anger)
• What is Type D behaviour?

  Distressed personality

  High levels of negative emotions & social inhibition

  Risk factors for adverse health outcomes in cardiac pts

  Highly activated immune systems & more inflammation

  Greater increases in BP reactivity to stress

  Engage in fewer health-promoting behaviours
• Fill in the blanks

  A) Symptom perception

  B) Cognitions

  C) Emotions

  D) illness threat

  E) emotions

  F) Appraisal

  
• How do anxiety & depression (emotional responses) impact CVD?

  Anxiety

  • physical symptoms of anxiety may be confused with symptoms of CVD
  • CVD can be a source of anxiety (Ix, MI, fear of over-exertion)

  Depression

  • flattened response, negative thoughts & reduced activity
  • strong predictor of 2nd MI & death
• What is the aim of cardiac rehabilitation?

  Help patient to recover quickly & completely as possible & reduce chance of recurrence

  Should be an integral step in management of patient's condition
• What are the psychological objectives of cardiac rehabilitation?

  Modify behavioural risk factors (lifestyle & stress)

  Improve psychological functioning

  Improve QoL
• Cardiac rehabilitation programmes have been shown to...

  Reduce psychological distress for patients & their families

  Improve CV fitness

  Reduce mortality & hospital readmissions

  Increase rate of return to paid employment

  Reduce health service costs
• What are the long term benefits of cardiac rehabilitation?

  After 12 months...

  • differences in psychosocial benefits decline
  • differences in physical benefits decline
  • some pts prefer home-based programmes
• Social determinants of heart disease

  
• Social Determinants of CVD

  
• Fill in the blanks

  A) Social & physical

  B) Psychological processes

  C) NS

  D) endocrine

  E) immune

  F) CV

  G) Resp

  H) Health behaviour

  I) Health

  
• How does depression affect prognosis of CVD?

  Biological affect

  • HPA axis dysfunction
  • reduced HR variability
  • increased inflammatory response & platelet activation
  • impaired vascular function

  Behaviour

  • poor adherence
  • lack of participation in cardiac rehabilitation

  Lifestyle

  • smoking, diet, sedentary

  Psychosocial

  • social isolation
  • chronic stress
  • co-morbid anxiety