title: [Impact of attachment style, social support and the number of implantable cardioverter defibrillator (ICD) discharges on psychological strain of ICD patients].
abstract: OBJECTIVE It is well known fact, that the life of ICD patients is often affected by anxiety and depression. The number of ICD discharges is only a contributing factor explaining the variance of anxiety and depression. There have to be other factors that have more influence on the physical strain of ICD patients. In this study we examined the impact of attachment style and social support in addition to the number of ICD discharges. METHODS 119 out-patients at an out-patient ICD unit were examined consecutively with the following self report scales: (1) the State-Trait-Anxiety Inventory (STAI), (2) the Beck Depression Inventory (BDI), (3) a short form of a social support questionnaire (F-SOZU), (4) the Bielefeld Partnership Expectations Questionnaire (BFPE) and (5) a specifically designed questionnaire for the assessment of sociodemografic data. To determine the frequency and timing of the ICD discharges we analysed the ICD data. RESULTS 38 % of the ICD patients reported enhanced anxiety levels and 37 % reported enhanced depression levels. Only 38 % of the ICD patients received discharges at all. Elevated levels of anxiety and depression were found in patients who showed insecure attachment styles, low social support, long-term treatment in hospital and a higher number of ICD discharges. To explain the variance of anxiety we found social support, attachment style, and the number of ICD storms to be contributing factors. To explain the variance of depression we found social support and time spent in hospital in the previous year to be contributing factors. CONCLUSIONS Almost half of the ICD patients suffer considerably from anxiety and/or depression. These patients have to be identified and treated psychotherapeutically. Patients who show insecure attachment styles, receive low social support, undergo long-term treatment in hospital and receive a higher number of discharges, especially so called ICD storms, bear the highest risk to develop psychological strain. Attachment style and social support have even more impact on the development of anxiety and depression than the number of ICD discharges. It has to be shown in future studies whether psychotherapy can improve the quality of life of ICD patients.
authors.affiliation: Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf. simson@st-agatha-krankenhaus.de
authors.forename: Udo
authors.initials: U
authors.lastname: Simson
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
authors.forename: Ariane
authors.initials: A
authors.lastname: Plaskuda
authors.forename: Ralf
authors.initials: R
authors.lastname: Schäfer
authors.forename: Michael
authors.initials: M
authors.lastname: Brehm
authors.forename: Doris
authors.initials: D
authors.lastname: Bader
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tress
authors.forename: Matthias
authors.initials: M
authors.lastname: Franz
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D011569:Psychiatric Status Rating Scales; D012944:Social Support; D011795:Surveys and Questionnaires