Correlates of Post-traumatic Growth Following a Myocardial Infarction: A Systematic Review

The longitudinal association of optimism with quality of life after percutaneous coronary intervention for coronary heart disease; The THORESCI study

BACKGROUND

Positive psychological factors such as optimism are predictive of favorable clinical outcomes in patients with cardiac disease. Evidence suggests that trait optimism can vary over time, especially after a coronary event. We therefore examined whether the level and change in optimism across the one-year time period after percutaneous coronary intervention (PCI) were associated with changes in quality of life (QoL) over time. The analyses were adjusted for negative psychological functioning and health behavior adherence as potential explanatory factors.

METHODS

Patients who underwent PCI (n = 1759, 21 % female, mean age = 64 ± 10 years) filled out a psychological survey including positive (optimism; LOT-R) and negative psychological factors (depression (PHQ9) and anxiety (GAD7)), QoL (WHOQOL-BREF), and health behavior adherence (MOS-GAS) at inclusion and one year later (n = 1474). Data were analyzed using hierarchical linear mixed modeling with time-varying predictors and covariates.

RESULTS

Optimism levels increased from baseline (MeanBL = 7.6 (SD = 2.1) to 1-year follow-up in 43 % of the patients, whereas optimism decreased in 36 %; rintraclass = 0.53). Optimism was associated with a higher level of overall QoL (B = 1.96, se = 0.09, p < .001) and more positive 1-year change in QoL (B = 0.55, se = 0.09, p < .001), adjusting for demographic and clinical covariates, with similar findings for all subdomains. Adding depression and anxiety (both significant negatively correlated with of QoL) explained part of the associations of optimism with physical, psychological and environmental QoL, but not with social QoL. Health behavior adherence was significantly correlated with most QoL components, but adherence did not affect the association between optimism and QoL.

CONCLUSION

These data indicate marked individual differences in the magnitude of changes in optimism following PCI. Both higher levels and increases in optimism were associated with higher and improving QoL. Depression and anxiety, but not health behavior adherence, explained part of this relationship. Optimism might be an important psychological factor to address in cardiac rehabilitation.

The mediating effects of resilience in the relationship between social support and posttraumatic growth in patients with acute coronary syndrome in China

Background

Posttraumatic growth has a positive impact on patients diagnosed with acute coronary syndrome (ACS). Patients with acute coronary syndrome in China report low to moderate levels of posttraumatic growth. Additionally, there is a dearth of research exploring the associations between resilience, social support, and posttraumatic growth in this specific patient population.

Objective

This study examined whether resilience serves as a mediator between social support and posttraumatic growth in patients with acute coronary syndrome who had been discharged for 1 to 6 months and were being followed up in clinics.

Methods

A descriptive correlational study design was utilized. A systematic sampling technique was used to recruit 121 patients with acute coronary syndrome who had been discharged for 1 to 6 months from cardiovascular clinics of a tertiary care hospital in Jiangsu Province, China. The research instruments included the demographic characteristics questionnaire, the Connor-Davidson Resilience Scale, the Multidimensional Scale of Perceived Social Support, and the Posttraumatic Growth Inventory. The data were collected between August 2022 and November 2022 and were analyzed using descriptive statistics and regression analyses to determine the mediating effects.

Results

The level of posttraumatic growth among patients with acute coronary syndrome attending follow-up clinic visits was moderate (Mean = 60.58, SD = 14.13). Resilience had a direct and positive impact on posttraumatic growth (β = 0.361, p <0.001). Moreover, resilience fully mediated the relationship between social support and posttraumatic growth (indirect effect = 0.203, 95% CI [0.076, 0.331]; direct effect = 0.162, p = 0.101).

Conclusion

Patients with acute coronary syndrome in China experience moderate posttraumatic growth after discharge. Resilience mediates the relationship between social support and posttraumatic growth. Therefore, nursing interventions focusing on promoting social support and resilience should be developed to encourage posttraumatic growth in patients with acute coronary syndrome.

Effects of posttraumatic growth on psychosocial adjustment in young and middle-aged patients with acute myocardial infarction: The mediating role of rumination

BACKGROUND

Psychosocial adjustment is a core problem faced by young and middle-aged patients following a diagnosis of acute myocardial infarction (AMI), which seriously affects rehabilitation outcomes. However, the relationship and influencing mechanism between post-traumatic growth and psychosocial adjustment in young and middle-aged AMI patients have not been fully explored.

OBJECTIVES

This study aimed to determine the relationship between posttraumatic growth and psychosocial adjustment in young and middle-aged patients following AMI and to explore the mediating role of rumination.

METHODS

This cross-sectional study was conducted in Guangdong Province from January 2022 to August 2022. A total of 321 young to middle-aged patients with AMI participated in this study. Self-reported questionnaires were used to assess posttraumatic growth, rumination, and psychosocial adjustment. Pearson's correlation and path analyses were used to analyze the data.

RESULTS

The total scores for posttraumatic growth, rumination, and psychosocial adjustment in young and middle-aged patients with AMI were 51.24±19.35, 35.18±8.72, and 43.55±26.04, respectively. All three were considered moderate. Posttraumatic growth was positively associated with rumination and negatively associated with psychosocial adjustment (p < 0.01). The relationship between posttraumatic growth and psychosocial adjustment was mediated by deliberate rumination.

CONCLUSIONS

Deliberate rumination mediated the relationship between posttraumatic growth and psychosocial adjustment. Healthcare providers should therefore guide patients to engage in deliberate rumination to help them grow following their AMI, thereby improving their psychosocial adaptability and prognosis.

Social support and posttraumatic growth: A meta-analysis

BACKGROUND

The beneficial role of social support on posttraumatic growth (PTG) has been assumed by theoretical models and established in some studies. However, there are inconsistent findings and little knowledge on moderators. The present study aims to investigate the overall effect size of the relationship and identify factors affecting the association.

METHODS

Six electronic databases were searched. Newcastle-Ottawa Quality Assessment Scale (NOS) were used to evaluate the quality of studies. Study quality, study design, trauma type, PTG measure, social support measure, continent, publishing language, sample size, gender, religion, and age were analyzed as moderators. Meta-regression was conducted with the significant differential predictors in moderator analysis.

RESULTS

The meta-analysis included 217 samples and a total of 47,940 participants from both longitudinal and cross-sectional studies. There was a medium positive effect size between social support and PTG in random effect model, r = 0.418, p < .001. The meta-regression analysis indicated that the association between social support and PTG was stronger among caregivers (vs. other traumatized samples), Chinese, older individuals and studies with smaller sample size.

LIMITATIONS

Only survey results were included in the analysis. The retrospective self-report may limit a more objective assessment of the relations. In addition, 87 % of the studies were cross-sectional, which may influence the estimation of a valid effect size.

CONCLUSIONS

Regarding the medium positive association between social support and PTG, it is important to enhance social support for trauma survivors. It will be especially effective for caregivers, Chinese, and older people.

Passing through end-of-life suffering: Possible or not? Results from a qualitative inquiry

The objective of this study was to understand the factors associated with "passing through suffering" in terminal illness. We interviewed 19 adults diagnosed with terminal disease in palliative stage. Interviews were analyzed using thematic analysis. Four axes of understanding were generated. In the first, participants discussed the will to "feel alive" despite the disease. The second, the process of acceptance, is based on lucidity and on letting go. The third highlights the importance of relationships with others. The fourth axis describes the consequences of this passage through suffering. This study highlights a phenomenon of adapting to suffering.

Perceived posttraumatic growth in cardiac patients: A systematic scoping review

Despite the life-threatening nature of many cardiac conditions, patients often report perceived posttraumatic growth (PPTG) in their recovery. To date, this research remains scattered across the literature, and no systematic review across cardiac patient populations is available. To understand the state of the literature on PPTG in cardiac patients, we conducted a systematic scoping review, aiming to (a) describe patient populations included, (b) characterize associations between PPTG and mental and physical health indices, (c) identify potential psychosocial resources that moderate or mediate the effects of a cardiac condition on PPTG, and (d) describe and critique study methodologies. A systematic search was conducted on June 21, 2021, using the PubMed and PsycInfo databases. Two authors independently screened the results for eligibility and resolved discrepancies before extracting study data. We identified 21 studies that met the search and eligibility criteria (i.e., original, peer-reviewed, English language). Most studies focused on a single cardiac condition (61.9%), with myocardial infarction the most common. PPTG was studied in relation to myriad mental health and physical health indices. The findings suggested that appraisal and coping may mediate and psychosocial resources (e.g., social support) may moderate the effects of a cardiac condition on PPTG. The generalizability of results is limited, as most studies employed a cross-sectional design with mostly male and majority White samples. Future research would benefit from studying PPTG in more diverse cardiac populations, assessing appraisals of the cardiac condition as traumatic, measuring posttraumatic depreciation in tandem with PPTG, and conducting prospective studies.