Anksioznost i strategije suočavanja sa stresom u dijagnostičkom pregledu kardiovaskularnih bolesnika

Abstract

Učestalost depresije i anksioznosti veća je kod osoba s kardiovaskularnim bolestima nego u općoj populaciji, ali u praksi ova stanja često ostaju neprepoznata, što osobito vrijedi za anksioznost. S obzirom da bolesti srca mogu značajno utjecati na kvalitetu života te su praćene visokom stopom mortaliteta za pretpostaviti je da i dijagnostički postupak može povećati razinu anksioznosti, depresije i stresa. U ovom odnosu značajnu ulogu mogu imati načini suočavanja sa stresom, anksiozna osjetljivost te percepcija bolesti, koji su u dosadašnjim istraživanjima uglavnom odvojeno razmatrani. Stoga je provedeno istraživanje s ciljem utvrđivanja doprinosa ovih varijabli u objašnjavanju stanja depresije, anksioznosti i stresa kod kardiovaskularnih pacijenata u postupku dijagnostike. U istraživanju je sudjelovao 151 pacijent (73 žene i 78 muškaraca) naručen na pregled u Kardiološki laboratorij Opće bolnice Zadar. Pacijenti su upitnike (DASS-21, ASI, COPE i IPQ-R) ispunjavali prije pregleda te su podijeljeni u tri kategorije s obzirom na razlog dolaska: prvi pregled, redovna kontrola i pregled zbog pogoršanja stanja. Utvrđeno je da pacijenti općenito imaju visoke razine depresije, anksioznosti i stresa, a kod pacijentica su ove razine značajno više u odnosu na muškarce. S obzirom na razlog dolaska pacijenti su se razlikovali samo u anksioznosti koja je značajno viša kod pacijenta koji dolaze prvi put, a koji također slabije razumiju njihovu bolest od ostalih pacijenata. Između pacijenata u ovim kategorijama nisu nađene značajne razlike u načinima suočavanja i anksioznoj osjetljivosti. Međutim, u ovom uzorku pacijenata značajno su se razlikovale žene od muškaraca kod kojih su značajno više razine anksiozne osjetljivosti, češće koriste suočavanje usmjereno na emocije i izbjegavanje, imaju nižu percepciju osobne i medicinske kontrole, svoju bolest više smatraju cikličnom i imaju veće emocionalne reprezentacije. Odabrani prediktori (dob, spol, anksiozna osjetljivost, suočavanje i percepcija bolesti) objašnjavaju oko polovinu ukupne varijance anksioznosti, depresije i stresa, s najvećim doprinosom anksiozne osjetljivosti i spola, pri čemu u odnosu između spola i ove tri varijable anksiozna osjetljivost ima medijacijski efekt. Također, pokazalo se da suočavanje usmjereno na emocije smanjuje, a izbjegavanje povećava stanje depresije, dok suočavanje usmjereno na problem smanjuje stanje stresa. Manja emocionalna kontrola bolesti i veće emocionalne reprezentacije povećavaju stanje depresije. Također, percepcija negativnih posljedica bolesti doprinosi većem stanju anksioznosti. Zaključno, rezultati pokazuju visoke razine depresije, anksioznosti i stresa kod pacijenata koji dolaze na pregled u Kardiološki laboratorij, osobito u samom postupku dijagnostike i kod žena, što treba uzeti u obzir u planiranju postupaka dijagnostike i tretmana.The frequency of depression and anxiety is higher in patients with cardiovascular diseases than in the general population. Although in practice this conditions often remain unrecognized, especially anxiety. Considering that heart diseases significantly affect the quality of life and that are followed by a high mortality rate, it is to assume that the diagnostic procedure can also increase the level of anxiety, depression and stress. Significant role in this relationship may have the ways of coping with stress, anxiety sensitivity and illness perception, which have been considered separately in previous research. Therefore, this research has been carried out to determine the contribution of these variables in explaining the state of depression, anxiety and stress in cardiovascular patients in the diagnostic procedure. The study was attended by 151 patients (73 women and 78 males) commissioned for the examination at the Cardiology Laboratory of the Hospital in Zadar. Patients completed questionnaires (DASS-21, ASI, COPE and IPQ-R) before they were divided into three categories regarding the reason of their arrival: first examination, regular check-up, examination due to deterioration of the condition. It has been established that patients generally have high levels of depression, anxiety and stress, which was significantly higher in female patients rather than men. Due to the reason of the arrival, the patients differed only in anxiety, significantly higher among the patients who came for the first time and had less understanding of their illness. No significant differences in the coping strategies and anxiety were found between these categories. However, in this sample, women had significantly higher levels of anxiety sensitivity, more often used coping focused on emotions and avoidance, lower perceptions of personal and medical control, more often considered their illness cyclical and had more emotional representations. Selected predictors (age, gender, anxiety sensitivity, coping and illness perception) explained about half of the total variance of anxiety, depression and stress, with the greatest contribution of anxiety sensitivity and gender, where in the relationship between gender and these three variables anxiety sensitivity has a mediation effect. Also, it has been shown that coping focused on emotions decreases, while avoidance increases the state of depression, while coping focused on problem decreases stress. Less emotional control of the illness and greater emotional representations increase the state of depression. Also, the perception of negative consequences of the illness contributes to a greater state of anxiety. In conclusion, the results show high levels of depression, anxiety and stress among the patients of the Cardiology Laboratory, especially in the diagnostic procedure itself and among women, which should be considered in the planning of diagnostic and treatment procedures