The psychological impact of CHD

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OBESITY AND CORONARY HEART DISEASE 373
showed that the most common causes derived from all methods were ‘smoking’, ‘stress’,
‘it’s in the family’, ‘working’ and ‘eating fatty foods’. The results also showed some
changes over time with patients being less likely to blame their behaviour and/or personality as time went on. Therefore both sufferers and non sufferers of CHD seem to
hold beliefs about the cause of an MI which might influence their subsequent risky
behaviour and reflect a process of adjustment once they have become ill.
The psychological impact of CHD
Research has addressed the psychological impact of having an MI in terms of psychological morbidity and measures of anxiety and depression. For example, Lane et al.
(2002) used a longitudinal design to assess changes in depression and anxiety immediately post MI, 2–15 days post MI and after 4 and 12 months. The results showed that
during hospitalization 30.9 per cent of patients reported elevated depression scores and
26.1 per cent reported elevated anxiety scores. The results also indicated that this
increase in psychological morbidity persisted over the year of study. Some research has
also explored whether such changes in psychological morbidity can be modified. For
example, Johnston et al. (1999b) evaluated the impact of a nurse counsellor led cardiac
counselling compared to normal care. The study used an RCT design with a one year
follow-up and patients and their partners were recruited within 72 hours of the
patients’ first MI. The results showed that although patients did not show particularly
raised levels of anxiety and depression whilst still in hospital, those who did not receive
counselling showed an increase in these factors following discharge. Counselling
seemed to minimize this increase. In contrast to the patients, the partners did show very
high levels of anxiety and depression whilst the patients were still in hospital. This
dropped to normal levels in those that received counselling. However, depression and
anxiety might not be the only consequences of CHD. Bury (1982) argued that illness
can be seen as a form of biographical disruption which requires people to question
‘what is going on here?’ and results in a sense of uncertainty. Radley has drawn upon
this perspective to explore how people adjust and respond to CHD (Radley 1984, 1989).
In particular, Radley argues that patients diagnosed with CHD try to resolve the dual
demands of symptoms and society. He suggests that people with a chronic illness such
as CHD need to establish a new identity as someone who has been ill but can be well
again. This need occurs against a backdrop of a family and friends who are worried
about their health and often results in the ill person persistently acting in a ‘healthy
way’ as a means to communicate that things are ‘back to normal’. This approach finds
reflection in theories of coping and the re-establishment of equilibrium described in
Chapter 3. The consequences of disease have also be explored in the context of
impairment, disability and handicap which is discussed in Focus on research 15.1,
next page.
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