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Coping and emotional well-being in patients with chronic heart failure
Dept of Clinical Sciences, Danderyd Hospital; Division of CardiovascularMedicine, Karolinska Institutet.ORCID iD: 0000-0002-1139-9489
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.

Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.

Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.

Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.

Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2015. , 82 p.
Keyword [en]
Heart failure; Coping; Illness perception; Emotional well-being; Quality of life; Intervention; Randomized controlled trial
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-1899ISBN: 978-91-7676-001-7 (print)OAI: oai:DiVA.org:rkh-1899DiVA: diva2:851034
Public defence
2015-09-11, Sal Henry Dunant, Teknikringen 1, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-07 Created: 2015-09-03 Last updated: 2015-09-07Bibliographically approved
List of papers
1. Coping, Sense of Coherence and the Dimensions of Affect in Patients with Chronic Heart Failure
Open this publication in new window or tab >>Coping, Sense of Coherence and the Dimensions of Affect in Patients with Chronic Heart Failure
2010 (English)In: European Journal of Cardiovascular Nursing, ISSN 1873-1953, E-ISSN 1474-5151, ISSN 1474-5151, Vol. 9, no 2, 118-125 p.Article in journal (Refereed) Published
Abstract [en]

Background: Living with chronic heart failure has an impact on several important dimensions of an individual's life. A patient's use of coping strategies may influence his or her health condition and emotional well-being.

Aim: To investigate factors that may relate to the coping strategies used by individuals with chronic heart failure and how the coping strategies are associated with positive and negative affect.

Methods: A cross-sectional research design was used. The participants provided demographic data and filled out three questionnaires: Sense of Coherence scale, Brief COPE and Positive Affect Negative Affect Schedule.

Results: No differences in relation to coping strategies were found with regard to New York Heart Association class. Substance use was associated with gender and age. Sense of coherence was negatively associated with denial, behavioural disengagement, venting and self-blame, and positively associated with acceptance. It was found that avoidant coping positively and sense of coherence negatively, predicted negative affect. Problem focused coping positively predicted positive affect. Socially supported coping predicted both negative and positive affect.

Conclusion: The present study found that the employment of different coping strategies and sense of coherence had an impact on affect and therefore also the emotional well-being among patients with chronic heart failure.

Place, publisher, year, edition, pages
Sage Publications, 2010
Keyword
chronic heart failure, coping, coping strategy, affect, sense of coherence
National Category
Nursing Health Sciences Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:rkh:diva-347 (URN)10.1016/j.ejcnurse.2009.11.006 (DOI)20022304 (PubMedID)
Available from: 2012-09-11 Created: 2012-09-11 Last updated: 2015-09-07Bibliographically approved
2. Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured
Open this publication in new window or tab >>Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured
Show others...
2015 (English)In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, 239-248 p.Article in journal (Refereed) Published
Abstract [en]

Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

Keyword
Heart failure; Factor analysis; Statistical; Adaption; Psychological; Quality of life; Self-report
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:rkh:diva-1840 (URN)10.14740/cr385w (DOI)
Available from: 2015-05-13 Created: 2015-05-13 Last updated: 2015-09-07Bibliographically approved
3. Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure
Open this publication in new window or tab >>Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure
Show others...
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, 704-713 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.

Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.

Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.

Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.

Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

Keyword
anxiety; avoidant coping; chronic heart failure; depression; illness perception; path analysis
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:rkh:diva-1897 (URN)10.1111/scs.12297 (DOI)26766405 (PubMedID)
Note

As manuscript in dissertation

Available from: 2015-09-02 Created: 2015-09-02 Last updated: 2017-01-13Bibliographically approved
4. Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial
Open this publication in new window or tab >>Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial
Show others...
2016 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, 537-548 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

Keyword
Heart failure, intervention, randomized controlled trial, follow-up, sense of control, affect
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:rkh:diva-1898 (URN)10.1177/1474515115625033 (DOI)26733462 (PubMedID)
Note

As manuscript in dissertation.

 

 

Available from: 2015-09-03 Created: 2015-09-02 Last updated: 2017-01-13Bibliographically approved

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