Psychosocial adjustment and health care practices following coronary artery bypass graft surgery (CABG).

While CABG prolongs life and relieves symptoms, many patients experience side effects which may have significant psychosocial impact. Prevention studies have shown the value of psychologicial interventions and lifestyle modification, but patient perceptions and behaviors post-CABG remain unknown. This study examined perceived health change and health-care practices in the post-CABG year as well as their effects on psychosocial adjustment, particularly current depression and general distress. Information regarding post-CABG depression and general distress, health care practices, social support, and non-cardiac chronic conditions was gathered though a questionnaire based on several standardized instruments. Additional cardiac, surgical, and demographic data, including a 6-month follow-up, were retrieved from a computer database. All patients between ages 40 to 80 years, admitted for first time CABG during 1993, were eligible. Of 196 patients (143 males) who returned the 6-month follow-up, 151 (77%, 112 males) completed the questionnaire designed for this study. Structural equational modeling (LISREL 8) and logistic regression analysis were utilized to assess the relationships among these variables. A Wilcoxon matched-pairs signed ranks test suggested that perceived current health was improved in comparison with pre-CABG health. A paired t-test indicated that current depression was decreased (one month post-CABG vs. one year post-CABG scores). LISREL path models showed that chronic non-cardiac illnesses strongly predicted both one month post-CABG and current depression as well as current distress. While 11% of patients pursued psychological interventions for post-CABG issues, 85% sought complementary approaches, including prayer (67%), exercise (45%), and lifestyle diet change (10%). As hypothesized, a significant inverse relationship between complementary therapy and current depression, controlling for one month post-CABG depression, was shown by path models, which explained 70% of the variation in current depression. Secondary analyses found females to be disadvantaged in a number of ways, especially by a higher number of non-cardiac chronic illnesses. In conclusion, this study found that patients felt healthier after CABG surgery. Those who pursued complementary therapies showed better psychosocial adjustment. A more active patient management and rehabilitation plan, through multidisciplinary approaches, is proposed. Interventional strategies with special attention to gender differences appear desirable.PhDSocial Work and PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105066/1/9635480.pdfDescription of 9635480.pdf : Restricted to UM users only