Psychological assessment in cardiac rehabilitation.
BACKGROUND
While there has been an upsurge of interest in the psychiatric correlates of myocardial infarction, little is known about the presence of psychological distress in the setting of cardiac rehabilitation.


METHODS
A consecutive series of 61 patients with recent myocardial infarction who participated in a cardiac rehabilitation program was evaluated by means of both observer-rated (DSM and DCPR) and self-rated (Psychosocial Index) methods. A follow-up of this patient population was undertaken (median = 2 years). Survival analysis was used to characterize the clinical course of patients.


RESULTS
Twenty percent of patients had a DSM-IV diagnosis (in half of the cases minor depression). An additional 30% of patients presented with a DCPR cluster, such as type A behavior and irritable mood. Only high levels of self-perceived stressful life circumstances and psychological distress approached statistical significance as a psychological risk factor for cardiovascular events after myocardial infarction.


CONCLUSIONS
Psychological evaluation of patients undergoing cardiac rehabilitation needs to incorporate both clinical (DSM) and subclinical (DCPR) methods of classification. Type A behavior was present in about a quarter of patients and can be studied in specific subgroups of cardiovascular patients defined by DCPR.
Rafanelli
Chiara
C
Department of Psychology, University of Bologna, Bologna, Italy. crafanelli@psibo.unibo.it
Roncuzzi
Renzo
R
Finos
Livio
L
Tossani
Eliana
E
Tomba
Elena
E
Mangelli
Lara
L
Urbinati
Stefano
S
Pinelli
Giuseppe
G
Fava
Giovanni A
GA
D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007508:Irritable Mood; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D010348:Patient Care Team; D011379:Prognosis; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D012803:Sick Role; D013315:Stress, Psychological / Q000150:complications; D016019:Survival Analysis; D014434:Type A Personality