植入式心脏除颤器电击与心理困扰：探讨植入式心脏除颤器相关担忧和感知控制的中介作用。
Implantable Cardioverter Defibrillator Shocks and Psychological Distress: Examining the Mediating Roles of Implantable Cardioverter Defibrillator-Related Concerns and Perceived Control.
出版信息
J Cardiovasc Nurs. 2020 Jan/Feb;35(1):66-73. doi: 10.1097/JCN.0000000000000610.
BACKGROUND
Although the implantable cardioverter defibrillator (ICD) has a survival benefit for the prevention of sudden cardiac death, ICD recipients commonly experience emotional distress as a consequence of ICD shocks.
OBJECTIVE
The aim of this study was to examine whether the association between ICD shocks and psychological distress (anxiety and depressive symptoms) is mediated by ICD-related concerns and perceived control among ICD recipients.
METHODS
This was a multinational cross-sectional observational study of 334 ICD recipients. Patients reported the number of shocks received since ICD implantation and completed questionnaires to assess anxiety, depressive symptoms, ICD-related concerns, and perceived control. A path analysis was conducted to explore the relationship of receiving ICD shocks with anxiety and depressive symptoms and the mediating effects of ICD-related concerns and perceived control.
RESULTS
Of the 334 ICD recipients, 39.2% experienced ICD shocks at least once since implantation. There was no direct effect of ICD shocks on anxiety and depressive symptoms. Experiencing ICD shocks was indirectly associated with an increased likelihood of anxiety and depressive symptoms via the pathways of ICD-related concerns and perceived control (indirect effects on anxiety = 0.060, 0.043; indirect effect on depressive symptoms = 0.025, 0.073).
CONCLUSION
Experiencing defibrillator shocks was associated with psychological distress in ICD recipients; the relationship was fully mediated by ICD-related concerns and perceived control. These results suggest that clinicians should routinely assess ICD-related concerns and perceived control in patients with ICD. Research is needed to develop and test interventions to decrease emotional distress related to the ICD shock experience.
背景
尽管植入式心脏复律除颤器（ICD）可提高预防心源性猝死的生存率，但 ICD 受者常因 ICD 电击而出现情绪困扰。
目的
本研究旨在探讨 ICD 电击与心理困扰（焦虑和抑郁症状）之间的关联是否通过 ICD 受者的 ICD 相关担忧和感知控制来介导。
方法
这是一项对 334 名 ICD 受者的多中心横断面观察性研究。患者报告自 ICD 植入以来接受的电击次数，并完成了评估焦虑、抑郁症状、ICD 相关担忧和感知控制的问卷。进行路径分析以探讨接受 ICD 电击与焦虑和抑郁症状的关系，以及 ICD 相关担忧和感知控制的中介作用。
结果
在 334 名 ICD 受者中，39.2%至少经历过一次 ICD 电击。ICD 电击对焦虑和抑郁症状没有直接影响。通过 ICD 相关担忧和感知控制的途径，经历 ICD 电击与焦虑和抑郁症状的发生几率增加呈间接相关（对焦虑的间接影响=0.060，0.043；对抑郁症状的间接影响=0.025，0.073）。
结论
经历除颤器电击与 ICD 受者的心理困扰有关；这种关系完全由 ICD 相关担忧和感知控制介导。这些结果表明，临床医生应常规评估 ICD 受者的 ICD 相关担忧和感知控制。需要研究开发和测试干预措施，以减少与 ICD 电击体验相关的情绪困扰。
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