psychological assessment of patients with myocardial infarction
at cardiac outpatient clinic of assiut university hospital
‫تقييم الحاله النفسيه للمرضى المصابين بجلطه قلبيه المترددين على العياده الخارجيه لمرضى القلب‬
‫بمستشفى اسيوط الجامعى‬
heba kadees marzouk
‫هبة قديس مرزوق‬
samir sayed abd elkader,alaa el-din mohamed darweesh,naglaa abdel megeed mohamed
‫ نجالء عبدالمجيد محمد‬،‫ عالء الدين محمد درويش‬،‫سمير سيد عبدالجبار‬
Abstract:
Summary
Despite significant progress in the treatment of coronary artery disease, myocardial infarction
is still the leading cause of death in many countries especially in the United States. It is
estimated that 1.5 million persons in the United States had a myocardial infarction Each year, in
the rate of one person has a heart attack every 29 seconds, and every 60 seconds one person
dies because of a heart attack, The continued high morbidity and mortality of myocardial
infarction may be due to a failure to address the role of psychosocial factors such as
depression, and anxiety in the incidence of myocardial infarction and affect greatly in the
recovery process, complication, recurrence, and at the end leads to mortality in spite of giving
advanced treatment. The recent studies confirmed the role of interaction of physical and
psychosocial factors related to morbidity after myocardial infarction. Myocardial infarction
spread in the Arabian countries in the last years especially with the different problems of our
life which full of psychological stressors and changes in life style, manner of eating, smoking
and addiction, all of them leads to myocardial infarction.
The study aimed to:
Psychological assessment of patients with myocardial infarction.
subjects
The total study sample was 119 patients with myocardial infarction who accepted to participate
in the study and gave an informed oral and written consent during one year period. The studied
sample consisted of 64% (78) Males and 36% (41) Females This study has been carried out in
cardiac outpatient clinic of Assiut University Hospital.
Data were collected through the following six tools:
1. Clinical data questionnaire (Appendix I):
It includes personal and clinical data. The personal data included patient’s ( name, age, sex,
level of education, occupation, address). And the clinical data included (Diagnosis, present
complains, onset of illness, predisposing factors, present treatment, family history,
complication and life style changes).
2. Socio economic status data scale (Appendix II):.
This scale is designed by Abd-El-Tawab (2004) to assess socioeconomic status of the family and
consists of 4 dimensions, which include the following:
- Parent’s level of education it included 8 items.
- Parent’s occupation it included 2 items.
- Total family monthly income it included 6 items.
- Life style of the family it included 3 items.
3-The symptom checklist-90-Revised (Elbehairy, 2004 (Appendix III)).
The SCL-90-R is a 90-item self-report symptom inventory developed by Clinical Psychometric
Research. It is designed primarily to reflect the psychological symptom pattern of psychiatric
and medical patients. A preliminary version of the scale was introduced by Derogatis and his
colleagues (Derogatis et al., 1973) and based on early clinical experiences. Psychometric analysis
was modified and validated in the revised (R) form (Derogatiset al., 1976).
Each item of the “ 90” is rated on a 5-point scale of distress (0-4), ranging from non-at-all at one
pole to “extremely “ at the other pole .The “90” is scored and interpreted in terms of 9 primary
symptom dimensions and 3 global indices of distress that are labeled:
1. Somatization.
2. Obsessive compulsive.
3. Interpersonal sensitivity.
4. Depression.
5. Anxiety.
6. Hostility.
7. Phobic anxiety.
8. Paranoid ideation.
9. Psychoticism.
4-Depression, Anxiety, Stress scale 42 (DASS-42) (Appendix IV)
Psychiatric properties of the Depression, Anxiety, Stress scale 42 items self report inventory
that yields that 3 factors: Depression, Anxiety and Stress. This measure proposes that physical
anxiety (fear symptomatology) and mental stress (nervous tension and nervous energy) factorout as two distinct domains.
5-Beck depression inventory scale (Appendix V)
It was developed by Beck (1992), The Arabic version of Beck depression inventory scale which
modified by Ghareeeb (1990). This scale is composed of (13 items) measured on points (0-3)
likert scale each containing four statements ranked in order of severity, The patient chooses the
statement closed to their present state.
6-Norbek Social Support Questionnaire(NSSQ) (Appendix VI)
The tool was originally developed by Norbeck et al. (1981) to measure patients social support. It
is translated into Arabic language by Taha & Wehieda (1985) and used in different studies as
Abd El-Aziz, et al, (1986). It includes 6 question, concerned with care and love, respect,
confidence, support of thoughts or actions, short term financial aid and long term aid. The
scale is rated from 1-5, for each question The sum of total scores in the response of the six
question reveals if the patient receive good or bad social supportive net work.
The main results yielded by this study were:
1. The studied sample consisted of 119 patients. Males represent 65.6% while Females
represents 34.4%. The mean age were 51.3±7.3 years 61.3 % of patients aged of 50 years or
more which ranged from 40-75 years. As regard level of education most of patients (33.6%)
were illiterate and 27.7% read and write 42% of them not working. Most of the studied sample
(87.4%) are in the middle level of socioeconomic status and 57.1% live in urban areas. 59.7% of
the total patients had bad social supportive net work.
2-Percentage of patients need clinical psychiatric intervention in order of frequency of
symptoms 65.5% stomatization, 54.6% obsession, 45.4% anxiety, 44.5% phobia, 42.9% paranoia,
39.5% depression, 37.8% hostility, 37.8% sensitivity, 36.1% psychosis. Most of males are
suffering from phobia (46.2%), depression (44.9%), sensitivity (41%) than females. Females have
a higher percentage of hostility than males 41.5%.
3-About 69.7% of the total sample had depression, (70.7% of females and 69.2% of males). 31.9%
of the total sample had severe depression (33.3% of males and 29.3% of females).
4- About 90.8% of the total sample had anxiety (92.3% of males, 87.8% of females). 59.7% of the
total sample had extremely severe anxiety and 16.8% had severe anxiety. No statistical
significance differences between sex and severity of anxiety.
5- About 67.2% of the total sample had stress, (66.7% of males and 68.8% of females), 37% of the
total sample had severe stress and No statistical significance differences between sex and
severity of stress.
6-As regards relationship between depression, anxiety, stress and social supportive net work,
patients had bad social supportive network liable for depression, anxiety and stress than those
had good social supportive net work. Patients had bad social supportive net work 33.8% of
them had severe depression, 69% had extremely severe anxiety, 43.7% had severe stress.
7-As regards demographic characteristics of patients in relation to level of depression, anxiety
and stress, patients with mild, moderate, severe depression, anxiety and stress were among
patients older than 50 years old, married, not working, and in the low and middle social class