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Myocardial infarction personality factors, coping strategies, depression and secondary prevention
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A longitudinal study with 400 patients diagnosed with myocardial infarction (MI) was conducted at the Cardiology department at Malmö University hospital in Sweden, between 2002 and 2005. The aim of the project was to identify personality and psychosocial factors, influencing patients’ actions and the prognoses after MI. The five factor model of personality, (measures on Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness), coping strategies, depressive symptoms, the impact on delay seeking emergency care, smoking habits and cardiac health care utilization were studied. This thesis reports the result from four papers. In paper I the aim was to investigate whether maladaptive behaviour in the serial Color Word Test (CWT) alone or in combination with any specific personality dimensions were associated with severity of the MI. The indicators of severity of disease were maximum levels above median of the cardiac biomarkers troponin I and creatine-kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF). The findings showed that maladaptive behaviour in combination with low scores on extraversion was associated with higher levels in cardiac biomarkers, following an MI. Another crucial factor for the prognoses and survival after a MI is early arrival to the emergency department and rapid intervention. In paper II we analysed the correlation of personality and psychosocial factors, with the time lag between the onset of coronary symptoms and seeking emergency hospital care. There was no significant conjunction in time delay and personality factors, coping strategies and depression. In paper III we examined whether personality traits, coping strategies and symptoms of depression were related to smoking cessation after an MI. Out of the 149 patients who smoked at baseline, 2 years follow-up data was available on 133 individuals, of these 44% (n=59) still smoked and 56% (n=74) had stopped smoking during the 2 years. Those who still smoked had lower score in the personality factor agreeableness, more lived alone and were unemployed in contrast to those who had stopped smoking. They also had significantly higher coping scores as confrontational behaviour. Finally, in paper IV we examined whether personality factors and depressive symptoms predicted cardiac health care utilization over the first two years after the MI event. Those MI patients showing traits of Neuroticism at baseline had significantly higher utilization at the out-patient cardiac clinic than those without. Individuals with a high score of depressive symptoms at baseline had instead a higher utilization of social workers and telephone contacts over the two year follow-up. In conclusion, we found that the personality factors extraversion, agreeableness and neuroticism were factors that had impact on MI severity, smoking cessation and out-patient clinic contacts, while delay in seeking acute care was not affected by personality factors, depression or coping strategies. Maladaptive behaviour and a confronting coping strategy influenced MI severity and smoking cessation 2 years after an MI. Taking personality factors and coping strategies more into consideration when caring for patients in cardiac rehabilitation might be indicated.

Place, publisher, year, edition, pages
Malmö University. Faculty of Health and Society , 2016. , p. 83
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 1
Keywords [en]
Acute myocardial infarction, Personality factors, Coping strategies, depression, smoking cessation, Secondary prevention
National Category
Humanities and the Arts
Identifiers
URN: urn:nbn:se:mau:diva-7309Local ID: 20214ISBN: 9789171046666 (print)ISBN: 9789171046673 (print)OAI: oai:DiVA.org:mau-7309DiVA, id: diva2:1404223
Note

Paper IV in dissertation as manuscript with title "Personality factors and depression as predictors of health care consumption during the first two years following a myocardial infarction"

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-16Bibliographically approved
List of papers
1. Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (The Secondary Prevention and Compliance following Acute Myocardial Infarction-study)
Open this publication in new window or tab >>Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (The Secondary Prevention and Compliance following Acute Myocardial Infarction-study)
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2011 (English)In: BMC Cardiovascular Disorders, E-ISSN 1471-2261, Vol. 11, no 45Article in journal (Refereed) Published
Abstract [en]

Background Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT) measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI).Methods MI-patients (n = 147) completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF) ≤ 50%.Results Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04) and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03). No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF. Conclusions Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-4856 (URN)10.1186/1471-2261-11-45 (DOI)000294287600001 ()21777467 (PubMedID)2-s2.0-79960564675 (Scopus ID)12384 (Local ID)12384 (Archive number)12384 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-12-01Bibliographically approved
2. The impact of personality factors on delay in seeking treatment of acute myocardial infarction
Open this publication in new window or tab >>The impact of personality factors on delay in seeking treatment of acute myocardial infarction
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2011 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, article id 21Article in journal (Refereed) Published
Abstract [en]

Background Early hospital arrival and rapid intervention for acute myocardial infarction is essential for a successful outcome. Several studies have been unable to identify explanatory factors that slowed decision time. The present study examines whether personality, psychosocial factors, and coping strategies might explain differences in time delay from onset of symptoms of acute myocardial infarction to arrival at a hospital emergency room. Methods Questionnaires on coping strategies, personality dimensions, and depression were completed by 323 patients ages 26 to 70 who had suffered an acute myocardial infarction. Tests measuring stress adaptation were completed by 180 of them. The patients were then categorised into three groups, based on time from onset of symptoms until arrival at hospital, and compared using logistic regression analysis and general linear models. Results No correlation could be established between personality factors (i.e., extraversion, neuroticism, openness, agreeableness, conscientiousness) or depressive symptoms and time between onset of symptoms and arrival at hospital. Nor was there any significant relationship between self-reported patient coping strategies and time delay. Conclusions We found no significant relationship between personality factors, coping strategies, or depression and time delays in seeking hospital after an acute myocardial infraction.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-4586 (URN)10.1186/1471-2261-11-21 (DOI)000292036200001 ()21595967 (PubMedID)2-s2.0-79956050411 (Scopus ID)12458 (Local ID)12458 (Archive number)12458 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
3. Smoking Cessation After Acute Myocardial Infarction in Relation to Depression and Personality Factors
Open this publication in new window or tab >>Smoking Cessation After Acute Myocardial Infarction in Relation to Depression and Personality Factors
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2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 2, p. 234-242Article in journal (Refereed) Published
Abstract [en]

Smoking is an important cardiovascular risk factor and smoking cessation should be a primary target in secondary prevention after a myocardial infarction (MI). The purpose of this study was to examine whether personality, coping and depression were related to smoking cessation after an MI MI patients a parts per thousand currency sign 70 years (n = 323, 73 % men, 58.7 +/- 8.3 years), participating in the Secondary Prevention and Compliance following Acute Myocardial Infarction study in Malmö, Sweden, between 2002 and 2005, were interviewed by a psychologist to assess coping strategies and completed Beck Depression and NEO Personality Inventories, in close proximity to the acute event. Correlation between smoking status (current, former and never), personality factors, coping and depression was assessed at baseline and 24 months after the MI using logistic regression and in a multivariate analysis, adjusting for age and sex Of the participating patients, 46 % were current smokers. Two years after the event, 44 % of these were still smoking. At baseline, current smokers scored higher on the depression and neuroticism scales and had lower agreeableness scores. Patients who continued to smoke after 2 years had higher scores on being confrontational (i.e. confrontative coping style) compared to those who had managed to quit. Patients who continued to smoke had significantly lower agreeableness and were more often living alone Personality, coping strategies and psychosocial circumstances are associated with smoking cessation rates in patients with MI. Considering personality factors and coping strategies to better individualise smoking cessation programs in MI patients might be of importance.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Personality factor, Depression, Smoking cessation, Acute myocardial infarction, Prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-5645 (URN)10.1007/s12529-015-9514-y (DOI)000372256300013 ()26475034 (PubMedID)2-s2.0-84960260518 (Scopus ID)23051 (Local ID)23051 (Archive number)23051 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved
4. Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction
Open this publication in new window or tab >>Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction
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2017 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 318-325Article in journal (Refereed) Published
Abstract [en]

Background: Whether personality factors and depressive traits affect patients’ utilization of health care following an acute myocardial infarction is relatively unknown. The aim of this study was to examine whether hospital-based health care utilization after a myocardial infarction was correlated with patients’ personality factors and depressive symptoms. Methods: We studied 366 myocardial infarction patients admitted to Malmö University Hospital between 2002 and 2005 who subsequently participated in a cardiac rehabilitation programme. The patients were followed for two years after their index event. We investigated whether personality factors and depressive traits were correlated with the participants’ health care utilization, defined as a) out-patient Cardiology visits and phone calls to a physician, nurse or a social worker, and b) acute visits or admissions to the Emergency or Cardiology Departments, using negative binominal regression analysis. Results: In unadjusted comparisons neuroticism predicted more out-patient contacts. This significance remained after adjusting for age, sex, smoking, alcohol consumption and size of the myocardial infarction (measured as max level on troponin-I and left ventricular ejection fraction). There were no significant correlations between other personality factors or depression and out-patient contacts. None of the personality factors or depression predicted acute admissions. Conclusion: Apart from neuroticism, personality factors did not explain utilization of health care in terms of Cardiology out-patient contacts or acute admissions in myocardial infarction patients participating in a cardiac rehabilitation programme. Neither did depressive symptoms predict more health care utilization. This might indicate a robust cardiac rehabilitation programme offered to the study subjects, minimizing the need for additional health care contacts.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Personality factors, depressive traits, myocardial infarction, health care utilization
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-4084 (URN)10.1177/1474515116666780 (DOI)000396200300007 ()27566599 (PubMedID)2-s2.0-85015094972 (Scopus ID)22621 (Local ID)22621 (Archive number)22621 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved

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