Denollet Johan, Martens Elisabeth J, Nyklícek Ivan, Conraads Viviane M, de Gelder Beatrice
CoRPS-Center of Research on Psychology in Somatic Disease, Tilburg University.
Health Psychol. 2008 May;27(3):302-8. doi: 10.1037/0278-6133.27.3.302.
Coronary artery disease (CAD) patients who report low distress are considered to be at low psychological risk for clinical events. However, patients with a repressive coping style may fail to detect and report signals of emotional distress. The authors hypothesized that repressive CAD patients are at risk for clinical events, despite low self-rated distress.
This was a prospective 5- to 10-year follow-up study, with a mean follow-up of 6.6 years. At baseline, 731 CAD patients filled out Trait-Anxiety (distress), Marlowe-Crowne (defensiveness), and Type D scales; 159 patients were classified as "repressive," 360 as "nonrepressive," and 212 as "Type D."
The primary endpoint was a composite of total mortality or myocardial infarction (MI); the secondary endpoint was cardiac mortality/MI.
No patients were lost to follow-up; 91 patients had a clinical event (including 35 cardiac death and 32 MI). Repressive patients reported low levels of anxiety, anger and depression at baseline, but were at increased risk for death/MI (21/159 = 13%) compared with nonrepressive patients (22/360 = 6%), p = .009. Poor systolic function, poor exercise tolerance, 3-vessel disease, index MI and Type-D personality--but not depression, anxiety or anger--also independently predicted clinical events. After controlling for these variables, repressive patients still had a twofold increased risk of death/MI, OR = 2.17, 95% CI = 1.10-4.08, p = .025). These findings were replicated for cardiac mortality/MI.
CAD patients who use a repressive coping style are at increased risk for clinical events, despite their claims of low emotional distress. This phenomenon may cause an underestimation of the effect of stress on the heart. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
报告低痛苦程度的冠心病（CAD）患者被认为临床事件的心理风险较低。然而，具有压抑应对方式的患者可能无法察觉和报告情绪困扰信号。作者推测，尽管自我评定的痛苦程度较低，但压抑型CAD患者仍有发生临床事件的风险。
这是一项前瞻性的5至10年随访研究，平均随访时间为6.6年。在基线时，731名CAD患者填写了特质焦虑量表（痛苦程度）、马洛-克劳恩量表（防御性）和D型量表；159名患者被归类为“压抑型”，360名患者被归类为“非压抑型”，212名患者被归类为“D型”。
主要终点是全因死亡率或心肌梗死（MI）的复合指标；次要终点是心脏死亡率/MI。
无患者失访；91名患者发生了临床事件（包括35例心源性死亡和32例MI）。压抑型患者在基线时报告的焦虑、愤怒和抑郁水平较低，但与非压抑型患者相比，其死亡/MI风险增加（159例中有21例，占13%），而非压抑型患者为360例中有22例，占6%，p = 0.009。收缩功能差、运动耐量差、三支血管病变、首次MI和D型人格——而非抑郁、焦虑或愤怒——也独立预测了临床事件。在对这些变量进行控制后，压抑型患者的死亡/MI风险仍然增加了两倍，OR = 2.17，95% CI = 1.10-4.08，p = 0.025）。这些发现对于心脏死亡率/MI也得到了重复验证。
采用压抑应对方式的CAD患者发生临床事件的风险增加，尽管他们声称情绪痛苦程度较低。这种现象可能导致对应激对心脏影响的低估。（PsycINFO数据库记录（c）2008美国心理学会，保留所有权利）
