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© Borgis - Postępy Nauk Medycznych 8/2015, s. 545-550
*Judyta Jabłońska-Brzozowska1, Alicja Nasiłowska-Barud1, Andrzej Wysokiński2, Wanda Furmaga-Jabłońska3
Zaburzenia lękowe oraz zaburzenia nastroju u pacjentów z zaburzeniami rytmu serca z Lublina i jego okolic – badanie pilotażowe
Mood and anxiety disorders in patients with cardiac arrhythmias from Lublin City and its province – pilot study
1Department of Clinical Psychology, Medical University, Lublin
Head of Department: prof. Alicja Nasiłowska-Barud, MD, PhD
2Department of Cardiology, Medical University, Lublin
Head of Department: prof. Andrzej Wysokiński, MD, PhD
3Department of Newborn and Infant Pathology, Medical University, Lublin
Head of Department: prof. Wanda Furmaga-Jabłońska, MD, PhD
Streszczenie
Wstęp. Chorobom kardiologicznym często towarzyszą zaburzenia nastroju oraz zaburzenia lękowe, które tworzą koło pobudzenia autonomicznego układu nerwowego. Proces ten przyczynia się do rozchwiania układu bodźco-przewodzącego serca.
Cel pracy. Celem pracy jest szczegółowa analiza stanów emocjonalnych u pacjentów z zaburzeniami rytmu serca.
Materiał i metody. Badanie zostało przeprowadzone na grupie 75 pacjentów z zaburzeniami rytmu serca, pochodzących z Lublina (grupa I) i jego okolic (grupa II). Lęk mierzono Skalą Samopoznania Cattella, kontrolę emocji skalą CECS (Courtauld Emotional Control Scale) Watsona i Greera, natomiast do pomiaru depresji użyto Inwentarza Objawów Depresyjnych Becka. Ankieta własna posłużyła do zebrania danych socjodemograficznych, takich jak: płeć, wiek, miejsce zamieszkania, poziom wykształcenia i sytuacja zawodowa.
Wyniki. Wyniki wskazują na istnienie istotnej statystycznie różnicy pomiędzy poziomem depresji w badanych grupach. Pozostałe wyniki nie różnicują badanych grup, jednakże odnotowano współwystępowanie poszczególnych rodzajów arytmii z elementami struktury lęku.
Wnioski. Charakterystyka lęku oraz kontroli emocji nie różnicuje badanych grup, w odróżnieniu od poziomu depresji, który jest statystycznie wyższy w grupie II, w której obserwuje się także niewielkie podwyższenie wszystkich wyników. Oznacza to znaczne nasilenie depresji oraz lęku uogólnionego w grupie pacjentów pochodzących z okolic Lublina.
Summary
Introduction. Co-existance of heart problems with mood and anxiety disorders creates the vicious circle of activation of autonomic nervous system, somatic symptoms and unpleased emotions, on which patients focus their attention. Due to this process emotional arousal may influence electro-stability of the heart.
Aim. Aim of the study was the investigation and detailed specification of mood and anxiety disorders patients living with cardiac arrhythmia according to their place of dwelling.
Material and methods. The study was carried out among 75 patients with cardiac arrhythmias, from Lublin City (group I) and Lublin’s province (group II). Anxiety was measured with the IPAT Anxiety Scale Cattell, emotional control with Courtauld Emotional Control Scale – CECS by Watson, Greer and BDI – Beck Depression Inventory. Sociodemographic questionnaire gathered data concerning sex, age, place of living, level of education, maintenance and occupational situation.
Results. The conducted research revealed that there is a statistical difference in depression level, no statistical difference however, between levels of anxiety and emotional control in patients with cardiac arrhythmias from Lublin City and its province. Moreover, the coexistence between specific types of arrhythmia and elements of anxiety structure was stated.
Conclusions. In conclusion, should be stated that there is no difference in emotional pattern between rural and urban patients with cardiac arrhythmias. However, rural patients presents slightly increased levels of anxiety and all its components, as well as emotional control. Level of depression however, clearly differentiates both groups. Depression and free floating anxiety disorder is higher in rural citizens.
Introduction
According to World Health Organization (1) in developed countries cardiovascular diseases remains the main cause of death. In 1995, 14 million people died from cardiovascular diseases. By 2015 however, this number will rise to 20 million (2).
Netherless, it is hard to track number of people who survived stroke or live with serious cardiovascular disease. What is more, the most common complication after survived stroke is development of heart rhythm abnormalities like arterial and ventricular fibrillation (VF). Still however, many patients develop cardiac arrhythmias as a primary sickness like inborn Wolff-Parkinsone-White syndrome (WPW).
Living with such a medical burden like endured stroke and facing new heart problems like heart rhythm disturbances, influences psychological functioning of patients. Socioeconomic factors, like place of living moderate emotional coping strategies, which can be transform to emotional disorders.
This paper proposes a differentiation of patients with cardiac arrhythmias accordingly to their place of living – Lublin city and its province. Mainly it considers the coexistence of anxiety, emotional control and depression of people suffering from cardiac conduction abnormalities.
Aim
Aim of this article was to take a look at psychological problems of patients with heart rhythm abnormalities according to the place of living and put some light on the co-existence of specific emotional states and some types of heart rhythm abnormalities.
Material and methods
The study has been conducted among 75 randomly selected patients both men and women, mean age 52.25 years from hospitalized with cardiac arrhythmias or cardiac conduction abnormalities from the Department of Cardiology Medical University of Lublin in year 2011. Examined patients were divided into two groups according to the place of living. Group I consisted of 39 patients from Lublin; group II gathered 36 from Lublin’s province. Research has been carried out personally by the inquirers. All of the tests were completed and valid.
Three types of psychological methods were used in the research: first – Self Analysis Form The IPAT Anxiety Scale by Raymond B. Cattell (3); second Courtauld Emotional Control Scale – CECS by M. Watson, S. Greer (4) and BDI – Beck Depression Inventory.
IPAT Anxiety Scale consists out of 40 items which represent five supplementing scales of anxiety: (1) “Q3” perfectionism, (2) “C-” emotional stability, (3) “L” vigilance, (4) “O” apprehension and (5) “Q4” tension. Each item can be evaluated from 0 to 2 points. IPAT scale divides anxiety into two main types: implicit – inner, unconscious, often reflected in psychosomatic ailment and explicit type reveled in nervousness and observable behavior. First 20 items of test corresponds with implicit anxiety, next 20 – with explicit anxiety. Total sum of both parts represents the general level of anxiety. The scores for each supplementing scale consisted out of indicated items, then summed up and normalized to standard ten according to sex and age of the respondent. Normalized scores can be marked in 10 points scale, where 1-3 is low, 4-7 average, and 8-10 high level of anxiety.
Courtauld Emotional Control Scale – CECS method has been created to measure subjective sense of controlling emotions in demanding situations. Four scales assess anger – AG, depression – D, anxiety – AX and general emotional control. Questionnaire is constructed with 21 items then divided into 3 scales, where every scale contains seven items. Maximum score for every scale is 28. Total score is a sum of all scales and reflects the general emotional control where it can be reached 84 points. The higher is the score, the higher is emotional control.
Scores gathered by BDI – Beck Depression Inventory establish level of depression. Scores from 0-11 revels no signs of depression, scores from 12-27 suggest mild depression, scores above 27 major depressive disorder.
All mean scores and standard deviation are gathered in table 1.
Table 1. Mean scores and standard deviation.
Group I
(Lublin citizens, N = 39)
IPAT Anxiety ScaleMDSD
Q34.231.98
C-5.772.35
L5.172.89
O6.772.51
Q48.052.06
IA15.285.59
CECSMDSD
AG16.875.00
D17.624.40
AN18.214.39
Total Emotional ControlMDSD
52.4411.53
BDIMDSD
119.12
Group II
(Province citizens, N = 36)
IPAT Anxiety ScaleMDSD
Q34.141.71
C-6.222.59
L5.832.44
O7.222.41
Q48.751.76
IA16.224.99
GA17.067.67
CECSMDSD
AG17.815.36
D19.144.31
AN18.925.04
Total Emotional ControlMDSD
54.759.76
BDIMDSD
14.68.51
Data from medical history were used for medical characteristic of the groups and conducted information like type of arrhythmia and type of treatment.
Statistical analysis was done with the STATISTICA 6 package. After check-up of data with the Kolmogorov-Smirnow (K-S) test and the Shapiro-Wilk W test statistical analysis was performed with the t-Student test, Spearman’s correlation rank test and the U Mann-Whitney test. P < 0.05 was considered as statistically significant. Statistical results are presented in figures and tables.
Results
Medical characteristic
All of the patients have been admitted to the Cardiological Department due to poor heart condition or heart discomfort. In all, 2 groups of cardiac arrhythmia were specified (1) life threatening heart rhythm disturbances – heart diseases and arrhythmias with indications for implantation cardioverter defibrillator (ICD), as a primary or secondary prevention of sudden cardiac death (SCD) (ventricular tachycardia/ventricular fibrillation VT/VF), (2) cardiac arrhythmias with recommendation to catheter ablation (focal ventricular arrhythmia, atrial fibrillation and flutter, tachycardia with narrow QRS, Wolff-Parkinson-White syndrome).
There was not observed any statistical difference in the type of cardiac arrhythmias in examined groups. Dominate disorder in patients from Lublin province (group II) life threatening ventricular tachycardia or flutter (33.33%). On the contrary, Lublin inhabitants (group I) mainly suffered from arterial fibrillation and flutter (33.33%). There was no difference in prevalence of tachycardia with narrow QRS in both groups. However the WPW syndrome, was more common for patients from group II (fig. 1).
Fig. 1. Percentage distribution of type of cardiac arrhythmia.

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Piśmiennictwo
1. World Health Organization: http://www.who.int/cardiovascular_diseases/about_cvd/en/index.html (access: 14.01.2013).
2. Valentín F, Bridget BK: Promoting Cardiovascular Health in the Developing World. A Critical Challenge to Achieve Global Health. National Academies Press (US), Washington (DC) 2010.
3. Cattell RB: Handbook for the IPAT anxiety scale questionnaire (self analysis form): Brief, verbal questionnaire, Q-form, as distinct from objective T-battery. Savoy, IL: Institute for Personality and Ability Testing 1957.
4. Watson M, Greer S: CECS – Skala Kontroli Emocji. [W:] Juczyński Z: Narzędzia pomiaru w promocji i psychologii zdrowia. Wyd. II, Pracownia Testów Psychologicznych, Warszawa 2009: 55-59.
5. Aldao A, Nolen-Hoeksema, S, Schweizer S: Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review 2010; 30: 217-231.
6. Jaeschke R, Siwek M, Grabski B, Dudek D: Współwystępowanie zaburzeń depresyjnych i lękowych Psychiatria. Via Medica 2010; 7: 189-197.
7. Kubzansky LD, Kawachi I: Going to the heart of the matter: Do negative emotions cause coronary heart disease? Journal of Psychosomatic Research 2000; 48: 323-337.
8. Gallo LC, Matthews KA: Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin 2003; 129: 10-51.
9. Stansfeld S, Fuhrer R: Social relations and coronary heart disease. [In:] Stansfeld S, Marmot M (eds.): Stress and the heart: Psychosocial pathways to coronary heart disease. BMJ Books, Londres 2002: 72-85.
10. Sirois BC, Burg MM: Negative emotion and coronary heart disease. A review. Behavior Modification 2003; 27: 83-102.
11. Gross JJ: Emotion Regulation: affective, cognitive, and social consequences. Psychophysiology 2002; 39: 281-291.
otrzymano: 2015-06-08
zaakceptowano do druku: 2015-07-09

Adres do korespondencji:
*Judyta Jabłońska-Brzozowska
Department of Clinical Psychology Faculty of Medicine Medical University
ul. Jaczewskiego 8, 20-954 Lublin
tel. +48 (81) 724-43-27
judyta.jablonska@umlub.pl

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