Elsevier

Heart & Lung

Volume 29, Issue 2, March–April 2000, Pages 97-104
Heart & Lung

Issues in Cardiovascular Nursing
Psychologic distress among spouses of patients undergoing cardiac rehabilitation*,**

https://doi.org/10.1067/mhl.2000.105753Get rights and content

Abstract

Objective: The goal of this study was to identify common sources of distress in spouses of patients undergoing cardiac rehabilitation and to compare spouses classified as being in distress and those classified as nondistressed on demographic variables, their experiences of stress, coping strategies employed, marital intimacy, and level of family functioning. The study aimed to describe the needs of spouses with respect to possible interventions. Design: A cross-sectional analysis was used. Setting: The study was located at the University of Ottawa Heart Institute Prevention and Rehabilitation Centre’s cardiac rehabilitation program. Outcome Measures: Scores on the Brief Symptom Inventory, Heart Disease Hassles Scale, Coping Strategies Inventory, Miller Intimacy Scale, and McMaster Family Assessment Device were used as outcome measures. Results: Two hundred thirteen female spouses of patients undergoing cardiac rehabilitation participated in this study. Sixty-six percent of the spouses met the criteria for distress. This was more common in younger spouses (51.99 ± 9.94 years) than in older spouses (55.74 ± 10.54 years) (t = –2.45; P =.013). Distressed spouses used disengagement coping strategies significantly more than the nondistressed spouses (t = 6.91; P =.0001). Distressed spouses also reported significantly less intimacy in their marriages (t = –3.99; P =.0001) and poorer family functioning (t = 5.86; P =.0001). The most prevalent symptoms of psychologic distress included feeling tense, having trouble falling asleep and feeling easily hurt. The most prevalent stressors were as follows: (1) worries about treatment, recovery, and prognosis (75.5%); (2) moodiness of the patient (66.7%); (3) worries about the patient returning to work and about money (38.8%); (4) sexual concerns (36.7%); and (5) helplessness or apathy on the part of the patient and increased spousal responsibility (36.1%). Conclusions: Spouses of patients undergoing cardiac rehabilitation should be screened for psychologic distress, and those in distress should be offered interventions focused on assisting them to deal with specific stressors related to their experience with a spouse with heart disease. Interventions indicated include stress-management techniques and encouraging the use of engagement coping strategies. In addition, marital and family concerns need to be directly addressed in support interventions. (Heart Lung® 2000;29:97-104.)

Section snippets

PURPOSE

The objectives of this study were the following: (1) to determine the prevalence and nature of psychologic distress in spouses of patients undergoing CR; (2) to identify the most common heart disease stressors experienced by these spouses (these stressors represent the adaptational demands faced by the spouses as a result of their partner’s heart disease); (3) to compare distressed and nondistressed spouses in terms of demographic variables and coping strategies used, heart disease stressors,

Design

We conducted a cross-sectional analysis of spouses of patients undergoing CR who provided data in the baseline phase of a spousal support intervention trial. Inclusion criteria were the following: (1) the spouse understood written and spoken English; (2) the patient undergoing CR had an MI, CABG, percutaneous transluminal coronary angioplasty, or angina and was currently a patient of the University of Ottawa Heart Institute Prevention and Rehabilitation Centre’s (HIPRC) rehabilitation program;

Brief Symptom Inventory

The Brief System Inventory (BSI)22 is a well-validated measure of psychologic distress in a general population. The Global Severity Index (GSI) subscale, which provides a reliable and valid measure of the general level of psychologic distress, served as the measure of adjustment. The 53 items represent a variety of psychologic symptoms measured on a 5-point Likert scale, with higher scores representing greater psychologic distress. The GSI has high internal consistency, with α ranges between

ANALYSIS

Spouses were categorized as either distressed or nondistressed on the basis of their score on the BSI. A score greater than or equal to 0.31 on the GSI summary score of the BSI categorized a spouse as distressed. This is the score that differentiates between distressed and nondistressed people in a nonclinical population.22 Unpaired t tests compared distressed and nondistressed groups on standardized scores (T scores) on heart disease hassles, coping strategies, marital intimacy, and level of

RESULTS

The Table includes the demographics of the distressed and nondistressed spouses included in the study, as well as information about the patient’s heart disease.

DISCUSSION

This study suggests that many spouses of patients undergoing CR experience significant levels of psychologic distress following the cardiac event. This finding is similar to the findings of studies of spouses of cardiac patients not in rehabilitation programs,1, 4, 27 where spouses might be expected to have less support. Our data suggest that the support a patient receives from a CR program and the opportunity for spouses to participate in the rehabilitation program education sessions are not

CONCLUSIONS AND RECOMMENDATIONS

Many spouses of patients undergoing CR experience psychologic distress and report numerous stressors related to living with a partner with heart disease. Spouses of patients undergoing CR, especially younger women, should be screened for psychologic distress, and those in distress should be offered interventions focused on assisting them to deal with specific stressors related to their experience. Interventions indicated include stress-management techniques and encouraging the use of engagement

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  • Cited by (0)

    *

    Supported by Heart and Stroke Foundation of Ontario grant B-2361.

    **

    Reprint requests: Pat O’Farrell, University of Ottawa Prevention and Rehabilitation Centre, 40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7.

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