title: Psychological morbidity after myocardial infarction in an area of deprivation in the UK: evaluation of a self-help package.
abstract: BACKGROUND
  Psychological morbidity after an acute myocardial infarction (AMI) is known to be common, but can be addressed by appropriate rehabilitation. The area in which this research was conducted experiences high rates of deprivation and of coronary heart disease and limited access to hospital-based rehabilitation. Responding to concern about psychological needs of AMI patients, a self-help package was introduced and evaluated alongside standard hospital-based cardiac rehabilitation.
  
  
  OBJECTIVE
  To evaluate the impact of a home-based self-help package (the Heart Manual), alongside existing cardiac rehabilitation provision, on psychological morbidity and health status after AMI. A secondary aim was to assess the suitability of the Heart Manual for older patients aged over 80 years.
  
  
  METHODS
  A controlled observational study, comparing two cohorts of patients discharged from hospital after AMI. The intervention group was given the self-help package in addition to standard care. The control group received standard care alone. Outcome measures used were the Hospital Anxiety and Depression Scale and the EuroQol.
  
  
  RESULTS
  The intervention group showed significant improvement in anxiety and depression scores after 3 months and nonsignificant improvement in general health status. Patients who attended hospital-based rehabilitation classes, and those aged over 80 years, also benefited from the intervention.
  
  
  CONCLUSIONS
  A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups.
authors.affiliation: ScHARR, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK. e.a.lacey@sheffield.ac.uk
authors.forename: E Anne
authors.initials: EA
authors.lastname: Lacey
authors.forename: R June
authors.initials: RJ
authors.lastname: Musgrave
authors.forename: Jenny V
authors.initials: JV
authors.lastname: Freeman
authors.forename: Angela M
authors.initials: AM
authors.lastname: Tod
authors.forename: Peter
authors.initials: P
authors.lastname: Scott
mesh_terms: D000359:Aftercare / Q000379:methods / Q000523:psychology / Q000592:standards; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008297:Male; D008370:Manuals as Topic / Q000592:standards; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D011204:Poverty Areas; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D013664:Teaching Materials / Q000592:standards