Psychosocial Factors in CHD
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This document summarizes Henndy Ginting's public defense on psychosocial factors in individuals with coronary heart disease. The defense assessed anxiety, depression, anger, social support, health behaviors, personality type, attentional bias, spirituality, and beliefs about disease in CHD patients. It found that distressed personality type, spirituality, attentional bias, and maladaptive beliefs were significantly associated with psychosocial problems in CHD. It also found that a video intervention program about CHD increased adaptive beliefs, decreased anxiety and depression. The defense concluded by suggesting valid psychosocial measures be used and that psychosocial diagnostics and interventions be considered and improved for Indonesian CHD patients.
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Psychosocial Factors in CHD
- 1. Psychosocial factors in individuals with coronary heart disease: Cognitions, emotions, and health behaviors Henndy Ginting Public defence Nijmegen, 16 April 2014
- 2. A letter from Pramoedya Ananta Toer “Saya sudah memberikan semuanya kepada Indonesia. Umur, kesehatan, masa muda sampai setua ini. Sekarang saya tidak bisa menulis-baca lagi. Dalam hitungan hari, minggu, atau bulan mungkin saya akan mati, karena penyempitan pembuluh darah jantung. Basa-basi tak lagi bisa menghibur saya.” “I have given everything to Indonesia. Age, health, youth until this old age. Now, I can not write-read any more. In a matter of days, weeks, or months perhaps I will die, because the narrowing of coronary arteries. Pleasantries can no longer comfort me.”
- 3. Coronary heart disease (CHD) Bad news: Life threatening and stressful life event (Byrne & Rosenman, 1990). CHD in Indonesia CHD = 18% (2nd) cause of death. (Hasnawaty et al., 2009; WHO, 2011). 10.8 million CHD patients (Depkes RI, 2008). Good news: Improvement in risk factors management and innovation in cardiac medications reduce mortality (e.g., Ford & Capewell, 2011; Hunink et al., 1997; Zaman et al., 2008)
- 4. Psychosocial problems Consequences as well as important risk factors of CHD (e.g., Yusuf et al., 2004; Zaman et al., 2008). Anxiety Anger Depression Perceived less social support Unhealthy behaviors
- 5. We assessed (in individuals with CHD): • Anxiety • Depression • Anger • Social support • Health behaviors • Personality type • Attentional bias • Spirituality • Maladaptive beliefs about the disease). We proposed: A video intervention program.
- 6. Measures adaptation Indonesian version of the Beck Depression Inventory-II (the Indo BDI-II): •Factorial similarity across groups •Construct validity •Discriminative power •Reliability •Cut-off point of 17 for mild depression
- 7. Distressed personality type (Type D) 11.. LLeessss hheeaalltthhyy aanndd mmoorree uunnhheeaalltthhyy bbeehhaavviioorrss.. 22.. LLeessss ppeerrcceeiivveedd ssoocciiaall ssuuppppoorrtt..
- 8. Spirituality in individuals with CHD Meaningfulness Trust Caring for others Spiritual activities Acceptance Connectedness with nature Transcendent experiences Connectedness with: •Self •Others/nature •Transcendent. Anxiety Depression Anger
- 9. Anxiety and attentional bias in CHD
- 10. Video information about CHD CG: No videotape Did not watch the video. Watched the video only. The video with opportunity to ask questions. Increased adaptive beliefs about the disease Decreased anxiety Decreased Depression
- 11. General conclusion • Type D personality, spirituality, attentional bias, and maladaptive beliefs are significant factors associated (positively or negatively) with psychosocial problems in CHD. • There was a benefit of the video intervention. • We suggested valid psychosocial measures (e.g., the Indo BDI-II).
- 12. Take home message Consider and improve psychosocial diagnostics and interventions in Indonesian individuals with CHD.
- 13. Thank you for your attention
Editor's Notes
- With the permission of the Council of Deans and in order to obtain the degree of doctor from Radboud University Nijmegen, I would like to defend in public my doctoral thesis entitled…, a doctoral thesis in the faculty of social science.
- I will start my presentation with a letter from Pramoedya Ananta Toer, a well known Indonesian writer whose books have been translated in to some languages including Dutch. This letter was written to respond Indonesian government apology for treated him as a political prisoner. He ended his letter with this message…. Pramoedya may be right because the narrowing of the coronary arteries which is an indication of a coronary heart disease (CHD), is a life threatening disease. However, he seemed to have a maladaptive belief about heart disease (e.g., He thought that CHD is an uncontrollable disease). This maladaptive belief could develop other psychosocial problems, such as depression and anger. next slide…
- Like Pramudya, once individuals are diagnosed to have CHD, they will face bad news and relatively good news regarding their disease. Beside life threatening, CHD is a stressful life event with high mortality rate and high prevalence. However, improvements in the management of CHD risk factors (living a healthy life style) and innovations in cardiac medications reduce CHD mortality. How CHD patients adjust with these bad and god news may determine the occurrence of psychosocial problems.
- It has been found that psychosocial problems, such as … (bacakan) can be consequences as well as important risk factors of CHD. These psychosocial problems influence the course of the disease, and turn out to be equal with other well known risk factors of CHD, such as hypertension and diabetes.
- Our studies in this thesis investigated the associations between those psychosocial problems and other psychosocial factors. More specifically, our studies’ aims were to investigate: 1. the role of Type D in health behaviors and perceived social support, 2. how spirituality is associated with negative emotions, 3. whether CHD patients would give more attention towards disease-related threat, and if such an attention is associated with anxiety, and 4. our last study is a video intervention program in which we examined how the beliefs about the disease, anxiety, and depression can be improved by communicating comprehensive information about CHD.
- As a preliminary work, we validated all measures used in this thesis. The validation of Indonesian version of the Beck Depression Inventory-II (the Indo BDI-II) was reported in this study. This validation study is important since there was no study that specifically validated psychosocial measures for individuals with CHD in Indonesia.
- After the validation, one of our studies investigated the distressed personality type (Type D) which has been associated with poor prognosis of CHD. Type D individuals tend to experience negative emotions across time and may also feel insecure and inhibited in social relationship. We found that Type D was associated with health behaviors and PSS. Type D individuals with CHD perceived less social support from family, friends, and significant others. Our study also suggested that Type D was associated with less physical activity, less fruit and vegetable consumption but higher fat intake, and less effort to control weight.
- In another study, we examined the associations between spirituality and negative emotions (depressive symptoms, anxiety, and anger) in CHD patients. Spirituality was defined as connectedness with self, with others including nature, and with the transcendent which are represented in 7 dimensions as shown on this slide. We found that higher level of spirituality was associated with lower levels of anxiety, depression, and anger. More specifically we found that higher level of trust is associated with lower levels of depression and anxiety, more caring for others is associated with less anxiety, and more connectedness with nature is associated with less anger.
- In one of our experimental studies, we found that compared with healthy participants, CHD patients needed more time and made more error in naming colors of the threatening words related to CHD. Such an attention was associated with anxiety, and a vicious circle may exist in this association. An anxious CHD patient tend to excessively giving attention to information or materials or event related to the disease (e.g., giving more attention to a chest pain) which increase anxiety. In addition, the results also indicated a possible deficit of executive functioning among individuals with CHD.
- Individuals with CHD in Indonesia have limited access to comprehensive information about the disease due to the low number of cardiologists, being afraid to ask more detail questions, and the tendency that medical doctors to overlook for patients’ psychosocial experiences. As a consequence, patients may have maladaptive beliefs about the disease, and increased levels of anxiety and depression. To approach this problem, in another experimental study, we developed a 25-minutes video featured 22 items of myths and the truth as well as common misconceptions about CHD. We found that adaptive beliefs of the patients was increased after watching the video. We also found the effect of watching the video which was reflected on lower anxiety and depression levels of the patients.
- To conclude, we found that Type D personality, spirituality, attentional bias, and maladaptive beliefs are significant factors associated with psychosocial problems in CHD. We showed the benefit of the video intervention, and evaluated validity of the psychosocial measures in CHD patients. These findings are generally in line with related literature and considerably contributed to our knowledge on psychosocial factors in CHD patients.
- As for clinical implications, our findings improve psychosocial diagnostics and interventions, and may raise the awareness of health care providers to consider psychosocial factors in CHD patients. There may be a significant number of CHD patients in Indonesia like Pramudya who have psychosocial problems related to their disease and our studies have given significant contributions to understand as well as to treat them better.
- “Having presented this summary of my doctoral thesis, I return the floor to the Rector.” ================================================= Later in the end of the ceremony: “Having defended my doctoral thesis to the best of my ability, I would like to thank the Rector, and my supervisor(s), as well as all those who have honoured this ceremony with their presence.”