冠状动脉疾病患者总体治疗依从性预测中正负性心理结构的相互关系与独立性——THORESCI研究结果

Interrelation and independence of positive and negative psychological constructs in predicting general treatment adherence in coronary artery patients - Results from the THORESCI study.

作者信息

van Montfort Eveline, Denollet Johan, Widdershoven Jos, Kupper Nina

机构信息

Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands.

Elisabeth Tweesteden hospital, Tilburg, the Netherlands and Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands.

出版信息

J Psychosom Res. 2016 Sep;88:1-7. doi: 10.1016/j.jpsychores.2016.06.009. Epub 2016 Jun 25.

DOI:10.1016/j.jpsychores.2016.06.009

PMID:27521644

Abstract

BACKGROUND

In cardiac patients, positive psychological factors have been associated with improved medical and psychological outcomes. The current study examined the interrelation between and independence of multiple positive and negative psychological constructs. Furthermore, the potential added predictive value of positive psychological functioning regarding the prediction of patients' treatment adherence and participation in cardiac rehabilitation (CR) was investigated.

METHOD

409 percutaneous coronary intervention (PCI) patients were included (mean age = 65.6 ± 9.5; 78% male). Self-report questionnaires were administered one month post-PCI. Positive psychological constructs included positive affect (GMS) and optimism (LOT-R); negative constructs were depression (PHQ-9, BDI), anxiety (GAD-7) and negative affect (GMS). Six months post-PCI self-reported general adherence (MOS) and CR participation were determined.

RESULTS

Factor Analysis (Oblimin rotation) revealed two components (r = − 0.56), reflecting positive and negative psychological constructs. Linear regression analyses showed that in unadjusted analyses both optimism and positive affect were associated with better general treatment adherence at six months (p < 0.05). In adjusted analyses, optimism's predictive values remained, independent of sex, age, PCI indication, depression and anxiety. Univariate logistic regression analysis showed that in patients with a cardiac history, positive affect was significantly associated with CR participation. After controlling for multiple covariates, this relation was no longer significant.

CONCLUSIONS

Positive and negative constructs should be considered as two distinct dimensions. Positive psychological constructs (i.e. optimism) may be of incremental value to negative psychological constructs in predicting patients' treatment adherence. A more complete view of a patients' psychological functioning will open new avenues for treatment. Additional research is needed to investigate the relationship between positive psychological factors and other cardiac outcomes, such as cardiac events and mortality.

摘要

背景

在心脏病患者中，积极的心理因素与改善医学和心理预后相关。本研究探讨了多种积极和消极心理构念之间的相互关系及独立性。此外，还研究了积极心理功能在预测患者治疗依从性和参与心脏康复（CR）方面的潜在附加预测价值。

方法

纳入409例接受经皮冠状动脉介入治疗（PCI）的患者（平均年龄 = 65.6 ± 9.5岁；78%为男性）。在PCI术后1个月进行自我报告问卷调查。积极心理构念包括积极情感（GMS）和乐观主义（LOT-R）；消极构念为抑郁（PHQ-9、BDI）、焦虑（GAD-7）和消极情感（GMS）。在PCI术后6个月确定自我报告的总体依从性（MOS）和CR参与情况。

结果

因子分析（斜交旋转）显示两个成分（r = -0.56），反映了积极和消极心理构念。线性回归分析表明，在未调整的分析中，乐观主义和积极情感均与6个月时更好的总体治疗依从性相关（p < 0.05）。在调整分析中，乐观主义的预测价值依然存在，独立于性别、年龄、PCI指征、抑郁和焦虑。单因素逻辑回归分析表明，在有心脏病史的患者中，积极情感与CR参与显著相关。在控制多个协变量后，这种关系不再显著。