Doedee Fleur, van den Houdt Sophie, Widdershoven Jos, Kupper Nina
Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Gen Hosp Psychiatry. 2021 Sep-Oct;72:45-52. doi: 10.1016/j.genhosppsych.2021.07.001. Epub 2021 Jul 13.
Fatigue is a prevalent symptom in patients with coronary heart disease (CHD). Individual differences in chronic stress may affect the experience and persistence of fatigue, and this may vary between the sexes. Therefore, we studied the effect of chronic stress on the course of fatigue over a 2-year period after percutaneous coronary intervention (PCI), and examined the moderating effects of sex.
1682 patients (78% men, age = 67.1 ± 10.6) were recruited and filled out multiple self-report questionnaires at baseline, one, 12, and 24 months post-PCI, including questions on demographics, fatigue (HCS). Multiple chronic stressors were assessed at baseline: work stress (ERI16), marital stress (MMQ-6), early life events (Life Events Questionnaire) and social stress. Latent class factor analysis (LatentGOLD) was used to construct a comprehensive chronic stress index. Linear mixed modeling examined the predictive quality of predictors and covariates.
Fatigue was found to substantially decrease over the first month post-PCI, then stabilized at a moderate level. Chronic stress impacted both the level and course of fatigue by increasing its level and delaying recovery. Overall and across time, women reported more fatigue than men. The level and course effects of chronic stress and sex were independent of demographic, health behavioral, and medical covariates.
Individual differences in chronic stress impact both the level and course of fatigue post-PCI, with women being affected most. Future research could further explain the mechanisms underlying the observed relationships. Developing and testing interventions focusing on exercise and stress-reduction could be used to alleviate fatigue.
疲劳是冠心病（CHD）患者中普遍存在的症状。慢性应激的个体差异可能会影响疲劳的体验和持续时间，且这种影响在性别之间可能有所不同。因此，我们研究了慢性应激对经皮冠状动脉介入治疗（PCI）后2年期间疲劳进程的影响，并考察了性别的调节作用。
招募了1682例患者（78%为男性，年龄=67.1±10.6岁），并在基线、PCI术后1个月、12个月和24个月时填写了多份自我报告问卷，包括人口统计学、疲劳（HCS）等问题。在基线时评估了多种慢性应激源：工作压力（ERI16）、婚姻压力（MMQ-6）、早年生活事件（生活事件问卷）和社会压力。采用潜在类别因子分析（LatentGOLD）构建综合慢性应激指数。线性混合模型检验了预测因素和协变量的预测质量。
发现疲劳在PCI术后第一个月大幅下降，然后稳定在中等水平。慢性应激通过提高疲劳水平和延迟恢复，对疲劳的水平和进程均产生影响。总体而言且在整个时间段内，女性报告的疲劳比男性更多。慢性应激和性别的水平及进程效应独立于人口统计学、健康行为和医学协变量。
慢性应激的个体差异对PCI术后疲劳的水平和进程均有影响，女性受影响最大。未来的研究可以进一步解释所观察到的关系背后的机制。开发和测试以运动和减压为重点的干预措施可用于减轻疲劳。
