Perez Glória Heloise, Nicolau José Carlos, Romano Bellkiss Wilma, Laranjeira Ronaldo
Department of Psychology, University of São Paulo Medical School, Brazil.
Eur J Cardiovasc Prev Rehabil. 2008 Feb;15(1):89-94. doi: 10.1097/HJR.0b013e3282f4b212.
The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (UA), in a smoke-free hospital.
Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n=268) and no humor disorder (n=135).
Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the 'precontemplation' stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P<0.001); 'precontemplation' stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P<0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P=0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P=0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P=0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P=0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P=0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P=0.018); and 'action' stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P=0.010).
Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.
本研究旨在调查在一家无烟医院中，抑郁症是否是因心肌梗死（MI）或不稳定型心绞痛（UA）住院患者出院后吸烟复发的预测因素。
对因MI或UA住院的当前吸烟者进行住院期间访谈；对被诊断为重度抑郁症（MD）或无情绪障碍的患者在出院后6个月进行再次访谈，以确定吸烟状况。比较MD患者（n = 268）和无情绪障碍患者（n = 135）之间复发的潜在预测因素（抑郁症；压力；焦虑；心脏病风险认知；咖啡和酒精消费；社会人口统计学、临床和吸烟习惯特征）。
复发者（40.4%）更频繁且更严重地抑郁，焦虑程度更高，自我效能感量表得分更低，诊断为UA，住院时间更短，开始吸烟年龄更小，戒烟尝试次数更少，配偶陪伴更少，且更频繁地处于“未考虑改变”阶段。多因素分析显示复发的阳性预测因素为MD[比值比（OR）：2.549；95%置信区间（CI）：1.519 - 4.275]（P < 0.001）；“未考虑改变”阶段（OR：7.798；95% CI：2.442 - 24.898）（P < 0.001）；既往冠状动脉搭桥手术（OR：4.062；95% CI：1.356 - 12.169）（P = 0.012）；以及既往使用抗焦虑药（OR：2.365；95% CI：1.095 - 5.107）（P = 0.028）。阴性预测因素为MI诊断（OR：0.575；95% CI：0.361 - 0.916）（P = 0.019）；住院时间（OR：0.935；95% CI：0.898 - 0.973）（P = 0.001）；吸烟起始年龄（OR：0.952；95% CI：0.910 - 0.994）（P = 0.028）；戒烟尝试次数（OR：0.808；95% CI：0.678 - 0.964）（P = 0.018）；以及“行动”阶段（OR：0.065；95% CI：0.008 - 0.532）（P = 0.010）。
抑郁症、缺乏动机、住院时间短和疾病严重程度导致急性冠状动脉综合征患者在医院启动戒烟后出院后重新吸烟。
