Heenan Adam, Greenman Paul S, Tassé Vanessa, Zachariades Fotini, Tulloch Heather
Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Département de Psychoéducation et de Psychologie, Universite du Québec en Outaouais, Gatineau, QC, Canada.
Front Psychol. 2020 Jan 28;11:75. doi: 10.3389/fpsyg.2020.00075. eCollection 2020.
Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.
Patients in a cardiac rehabilitation program ( = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.
Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios.
Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.
心血管疾病（CVD）心理社会风险因素的研究已将创伤应激和依恋风格确定为CVD发生的独立风险因素，以及已患CVD者预后不良的独立风险因素。探索这些变量之间的相互关系将为心理社会风险因素建模和潜在的干预途径提供信息。因此，对依恋风格与心脏康复（CR）患者健康结局相关且创伤应激介导这种关系的假设进行了检验。
心脏康复项目中的患者（n = 201）在基线（项目入组时）完成了经过验证的创伤应激和依恋风格的自我报告测量。在基线和3个月时评估健康结局，包括焦虑、抑郁、生活质量、空腹血糖、糖化血红蛋白（HbA1c）和胆固醇（高密度脂蛋白比率）。使用多变量结构方程模型对数据进行拟合。
在201名参与者中，42名（21%）的创伤评分表明可能存在创伤后应激障碍。通过更高水平的创伤应激，基线时更高的依恋焦虑与更高的焦虑、抑郁、空腹血糖和HbA1c以及更差的身心健康生活质量间接相关。对高密度脂蛋白比率没有显著的间接影响。
更高的依恋焦虑预示着更大的创伤应激；反过来，这又预示着更差的健康结局。对CVD患者的这些构念进行筛查和治疗是有必要的。
