Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain.
Escuela Andaluza de Salud Pública, Granada, Spain.
Br J Health Psychol. 2020 May;25(2):305-323. doi: 10.1111/bjhp.12408. Epub 2020 Feb 17.
Objectives Both pre-hospital decision delay - the time patients wait before seeking medical attention after symptoms have started - and high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors. Design A cross-sectional study of 102 consecutive, clinically stable ACS survivors. Methods Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted. Results Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables. Conclusions Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients' mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Statement of Contribution What is already known on this subject? Longer pre-hospital decision delay, that is waiting longer to seek medical attention after symptoms have started, predicts poor prognosis of acute coronary syndrome patients. High psychological distress post-ACS, such as the development of anxiety and/or depression, also predicts poor prognosis of these patients. What does this study adds? This study identifies several psychosocial markers of longer prehospital decision delay and high psychological distress post-ACS. Prehospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress, and these relationships were mediated by longer prehospital decision delay. Resilience was related to lower psychological distress post-ACS.
患者在出现症状后等待就医的时间（即院前决策延误）以及心脏事件后的心理困扰程度较高，均预示着急性冠状动脉综合征（ACS）患者的预后不良。本研究旨在确定这些预后因素的心理社会标志物。
对 102 例连续的、临床稳定的 ACS 幸存者进行的横断面研究。
参与者完成了一份问卷，其中包括院前决策延误、心理困扰以及与心血管健康相关的几个已知心理社会因素：D 型人格、韧性、社会支持以及在心脏事件期间的担忧。进行了多元线性回归和中介分析。
D 型人格和对延迟寻求帮助的严重后果的担忧较少与 ACS 后心理困扰程度更高相关，并且这种关系通过院前决策延误时间更长来介导。相比之下，韧性与较低的心理困扰相关。社会支持和对寻求帮助的社会关注与结果变量无关。
D 型人格可能是 ACS 患者更延迟寻求帮助和心脏事件后心理困扰程度更高的危险因素。相比之下，韧性是患者心脏事件后心理健康的潜在保护因素。院前决策延误与思考严重后果（例如，并发症、保护家人）有关，但与心脏事件期间的社会关注（例如，浪费他人时间）无关。
目前在该领域已知的是什么？
更长的院前决策延误，即出现症状后等待更长时间寻求医疗帮助，预示着 ACS 患者的预后不良。ACS 后较高的心理困扰程度，如焦虑和/或抑郁的发展，也预示着这些患者的预后不良。
本研究有何新发现？
本研究确定了院前决策延误和 ACS 后心理困扰程度较高的几个心理社会标志物。在心脏事件期间，院前决策延误与思考严重后果（例如，并发症、保护家人）有关，但与社会关注（例如，浪费他人时间）无关。D 型人格和对延迟寻求帮助的严重后果的担忧较少与更多的心理困扰相关，这种关系通过更长的院前决策延误来介导。韧性与 ACS 后较低的心理困扰相关。
