Hopelessness and depression in myocardial infarction
Psychosocial factors, such as depression, have been identified as important predictors of morbidity and mortality in individuals with coronary heart disease; however, little research has been done examining hopelessness in this population. This investigation examined the frequency and severity of hopelessness and depression symptoms in the early recovery period after hospitalization for myocardial infarction (MI), the relationship between hopelessness and depression symptoms, patient characteristics leading to these two constructs, and the effect of hopelessness symptoms on cardiac rehabilitation exercise participation and physical functioning post-MI. A sample of 351 men and women who were hospitalized for MI at five hospitals in central Michigan were interviewed after discharge home (approximately 14 days) and at three months after hospital discharge. Measures included the cognitive expectations factor of the Beck Hopelessness Scale®, Center for Epidemiologic Studies - Depression Scale, a cardiac rehabilitation exercise participation questionnaire, and the Activity Status Index. Both hopelessness and depression symptoms were frequent and moderate to severe in a portion of the sample at baseline and three months, yet depression symptoms significantly decreased from baseline to three months whereas hopelessness symptoms did not. Hopelessness symptoms were strongly associated with symptoms of depression at three months after hospital discharge. However, 10% of the sample had symptoms of hopelessness but minimal or no symptoms of depression, while another 10% had symptoms of depression but minimal or no hopelessness symptoms. There were some differences in baseline patient characteristics leading to hopelessness symptoms versus depression symptoms. In addition, baseline hopelessness symptoms were predictive of not starting a hospital-based cardiac rehabilitation exercise program and of quitting a hospital-based exercise program early, whereas depression symptoms had no such effect. Both hopelessness and depression symptoms at baseline accounted for an independent portion of variance in physical functioning at three months after hospital discharge. This descriptive study is an important early step in the research of hopelessness symptoms after an acute MI. Longitudinal modeling of the pathways among hopelessness symptoms, depression symptoms, and health-related outcomes is needed to further discern the relationship between hopelessness and depression symptoms, the distinction of these two constructs, and their effects on post-MI outcomes.
0347: Mental health