Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients
Corresponding Author
Ingvild M Morken MSc, RN
PhD Student
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
Department of Health Studies, University of Stavanger, Stavanger, Norway
Correspondence: Ingvild M Morken, PhD Student, Department of Cardiology, Stavanger University Hospital and Department of Health Studies, University of Stavanger, Stavanger, Norway. Telephone: +4751525496; +4791510483.
E-mail:[email protected]
Search for more papers by this authorEdvin Bru PhD
Professor
Department of Health Studies, University of Stavanger, Stavanger, Norway
Centre for Behavioural Research, University of Stavanger, Stavanger, Norway
Search for more papers by this authorTone M Norekvål PhD, RN
Associate Professor
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Institute of Medicine, University of Bergen, Bergen, Norway
Search for more papers by this authorAlf I Larsen MD, PhD
Professor
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
Institute of Medicine, University of Bergen, Bergen, Norway
Search for more papers by this authorThormod Idsoe PhD
Psychologist and Professor
Centre for Behavioural Research, University of Stavanger, Stavanger, Norway
Norwegian Institute of Public Health, Oslo, Norway
Search for more papers by this authorBjørg Karlsen PhD, RN
Associate Professor
Department of Health Studies, University of Stavanger, Stavanger, Norway
Search for more papers by this authorCorresponding Author
Ingvild M Morken MSc, RN
PhD Student
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
Department of Health Studies, University of Stavanger, Stavanger, Norway
Correspondence: Ingvild M Morken, PhD Student, Department of Cardiology, Stavanger University Hospital and Department of Health Studies, University of Stavanger, Stavanger, Norway. Telephone: +4751525496; +4791510483.
E-mail:[email protected]
Search for more papers by this authorEdvin Bru PhD
Professor
Department of Health Studies, University of Stavanger, Stavanger, Norway
Centre for Behavioural Research, University of Stavanger, Stavanger, Norway
Search for more papers by this authorTone M Norekvål PhD, RN
Associate Professor
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Institute of Medicine, University of Bergen, Bergen, Norway
Search for more papers by this authorAlf I Larsen MD, PhD
Professor
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
Institute of Medicine, University of Bergen, Bergen, Norway
Search for more papers by this authorThormod Idsoe PhD
Psychologist and Professor
Centre for Behavioural Research, University of Stavanger, Stavanger, Norway
Norwegian Institute of Public Health, Oslo, Norway
Search for more papers by this authorBjørg Karlsen PhD, RN
Associate Professor
Department of Health Studies, University of Stavanger, Stavanger, Norway
Search for more papers by this authorAbstract
Aims and objectives
To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease (PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals.
Background
Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms.
Design
Cross-sectional survey design.
Methods
Recipients (n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals.
Results
The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms.
Conclusions
The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety.
Relevance to clinical practice
Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out.
References
- American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. American Psychiatric Association, Washington, DC.
- Bolse K, Hamilton G, Flanagan J, Caroll D & Fridlund B (2005) Ways of experiencing the life situation among US patients with an implantable cardioverter defibrillator: a qualitative study. Progress in Cardiovascular Nursing 20, 4–10.
- Bolse K, Johansson I & Stromberg A (2011) Organisation of care for Swedish patients with an implantable cardioverter defibrillator, a national survey. Journal of Clinical Nursing 20, 2600–2608.
- Bolse K, Thylen I & Stromberg A (2012) Healthcare professionals' experiences of delivering care to patients with an implantable cardioverter defibrillator. European Journal of Cardiovascular Nursing, in press. Doi: 10.1177/1474515112457133.
10.1177/1474515112457133 Google Scholar
- Boriani G, Auricchio A, Klersy C, Kirchhof P, Brugada J, Morgan J & Vardas P (2011) Healthcare personnel resource burden related to in-clinic follow-up of cardiovascular implantable electronic devices: a European Heart Rhythm Association and Eucomed joint survey. Europace 13, 1166–1173.
- Borja SE, Callahan JL & Long PJ (2006) Positive and negative adjustment and social support of sexual assault survivors. Journal of Traumatic Stress 19, 905–914.
- Brewin CR & Holmes EA (2003) Psychological theories of posttraumatic stress disorder. Clinical Psychology Review 23, 339–376.
- Brewin CR, Dalgleish T & Joseph S (1996) A dual representation theory of posttraumatic stress disorder. Psychological Review 103, 670–686.
- Brewin CR, Andrews B & Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748–766.
- Charuvastra A & Cloitre M (2008) Social bonds and posttraumatic stress disorder. Annual Review of Psychology 59, 301–328.
- Clark AM, Jaarsma T, Strachan P, Davidson PM, Jerke M, Beattie JM, Duncan A, Ski CF & Thompson DR (2011) Effective communication and ethical consent in decisions related to ICDs. Nature Reviews Cardiology 8, 694–705.
- Cohen S & Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychological Bulletin 98, 310–357.
- Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP, Greene HL, Boczor S, Domanski M, Follmann D, Gent M & Roberts RS (2000) Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. European Heart Journal 21, 2071–2078.
- Creamer M, Bell R & Failla S (2003) Psychometric properties of the Impact of Event Scale – Revised. Behaviour Research and Therapy 41, 1489–1496.
- Denollet J (2005) DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosomatic Medicine 67, 89–97.
- Devine EC (1992) Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies. Patient Education and Counseling 19, 129–142.
- Dougherty CM, Thompson EA & Lewis FM (2005) Long-term outcomes of a telephone intervention after an ICD. Pacing and Clinical Electrophysiology 28, 1157–1167.
- Dunbar SB, Langberg JJ, Reilly CM, Viswanathan B, McCarty F, Culler SD, O'Brien MC & Weintraub WS (2009) Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients. Pacing and Clinical Electrophysiology 32, 1259–1271.
- Eid J, Larsson G, Johnsen BH, Laberg JC, Bartone PT & Carlstedt B (2009) Psychometric properties of the Norwegian Impact of Event Scale – Revised in a nonclinical sample. Nordic Journal of Psychiatry 63, 426–432.
- Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Riegel B, Tarkington LG & Yancy CW (ACC/AHA/HRS) (2008) Guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for thoracic Surgery and Society of Thoracic Surgeons. Circulation 117, 350–408.
- Field A (2009) Discovering Statistics Using SPSS, 3rd edn. SAGE Publication, London.
- Foa EB, Huppert JD & Cahill SP (2006) Emotional processing theory. An update. In Pathological Anxiety: Emotional Processing in Etiology and Treatment ( BO Rothbaum ed.). Guildfords Publications, New York, NY, pp. 3–24.
- Godemann F, Butter C, Lampe F, Linden M, Schlegl M, Schultheiss HP & Behrens S (2004) Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator. Clinical Cardiology 27, 321–326.
- Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER & Andrews ML (2004) Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II). Journal of the American College of Cardiology 43, 1459–1465.
- Habibovic M, van den Broek KC, Alings M, Van der Voort PH & Denollet J (2012) Posttraumatic stress 18 months following cardioverter defibrillator implantation: shocks, anxiety, and personality. Health Psychology 31, 186–193.
- Hallas CN, Burke JL, White DG & Connelly DT (2010) Pre-ICD illness beliefs affect postimplant perceptions of control and patient quality of life. Pacing and Clinical Electrophysiology 33, 256–265.
- Horowitz MJ, Wilner N & Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosomatic Medicine 41, 209–218
- Irvine J, Firestone J, Ong L, Cribbie R, Dorian P, Harris L, Ritvo P, Katz J, Newman D, Cameron D, Johnson S, Bilanovic A, Hill A, O'Donnell S & Sears S Jr (2011) A randomized controlled trial of cognitive behavior therapy tailored to psychological adaptation to an implantable cardioverter defibrillator. Psychosomatic Medicine 73, 226–233.
- Johansen JB, Mortensen PT, Videbaek R, Riahi S, Moller M, Haarbo J & Pedersen SS (2011) Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals. Europace 13, 663–667.
- Kamphuis HC, Verhoeven NW, Leeuw R, Derksen R, Hauer RN & Winnubst JA (2004) ICD: a qualitative study of patient experience the first year after implantation. Journal of Clinical Nursing 13, 1008–1016.
- von Kanel R, Baumert J, Kolb C, Cho EY & Ladwig KH (2011) Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator. Journal of Affective Disorders 131, 344–352.
- Kapa S, Rotondi-Trevisan D, Mariano Z, Aves T, Irvine J, Dorian P & Hayes DL (2010) Psychopathology in patients with ICDs over time: results of a prospective study. Pacing and Clinical Electrophysiology 33, 198–208.
- Karlsen B, Idsoe T, Hanestad B, Murberg T & Bru E (2004) Perceptions of support, diabetes-related coping and psychological well-being in adults with type 1 and type 2 diabetes. Psychology, Health and Medicine 9, 53–70.
10.1080/13548500310001637751 Google Scholar
- Kessler RC, Sonnega A, Bromet E, Hughes M & Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.
- Koivula M, Paunonen-Ilmonen M, Tarkka MT, Tarkka M & Laippala P (2002) Social support and its relation to fear and anxiety in patients awaiting coronary artery bypass grafting. Journal of Clinical Nursing 11, 622–633.
- Kuhl EA, Dixit NK, Walker RL, Conti JB & Sears SF (2006) Measurement of patient fears about implantable cardioverter defibrillator shock: an initial evaluation of the Florida Shock Anxiety Scale. Pacing and Clinical Electrophysiology 29, 614–618.
- Ladwig KH, Baumert J, Marten-Mittag B, Kolb C, Zrenner B & Schmitt C (2008) Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: results from the prospective living with an implanted cardioverter-defibrillator study. Archives and General Psychiatry 65, 1324–1330.
- Magyar-Russell G, Thombs BD, Cai JX, Baveja T, Kuhl EA, Singh PP, Montenegro Braga Barroso M, Arthurs E, Roseman M, Amin N, Marine JE & Ziegelstein RC (2011) The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: a systematic review. Journal of Psychosomatic Research 71, 223–231.
- Morken IM, Severinsson E & Karlsen B (2010) Reconstructing unpredictability: experiences of living with an implantable cardioverter defibrillator over time. Journal of Clinical Nursing 19, 537–546.
- Oftedal B, Bru E & Karlsen B (2011) Social support as a motivator of self-management among adults with type 2 diabetes. Nursing and Healthcare of Chronic Illness 3, 12–22.
10.1111/j.1752-9824.2010.01074.x Google Scholar
- Ozer EJ, Best SR, Lipsey TL & Weiss DS (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin 129, 52–73.
- Palacios-Cena D, Losa-Iglesias ME, Alvarez-Lopez C, Cachon-Perez M, Reyes RA, Salvadores-Fuentes P & Fernandez-de-Las-Penas C (2011) Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. Journal of Advanced Nursing 67, 2537–2550.
- Pauli P, Wiedemann G, Dengler W, Blaumann-Benninghoff G & Kuhlkamp V (1999) Anxiety in patients with an automatic implantable cardioverter defibrillator: what differentiates them from panic patients? Psychosomatic Medicine 61, 69–76.
- Pedersen SS, van Domburg RT, Theuns DA, Jordaens L & Erdman RA (2005) Concerns about the implantable cardioverter defibrillator: a determinant of anxiety and depressive symptoms independent of experienced shocks. American Heart Journal 149, 664–669.
- Pedersen SS, van den Broek KC & Sears SF Jr (2013) Psychological intervention following implantation of an implantable defibrillator: a review and future recommendations. Pacing and Clinical Electrophysiology 166, 215–220.
10.1016/j.ccep.2013.01.014 Google Scholar
- Pedersen SS, Theuns DA, Jordaens L & Kupper N (2010a) Course of anxiety and device-related concerns in implantable cardioverter defibrillator patients the first year post implantation. Europace 12, 1119–1126.
- Pedersen SS, Van Den Broek KC, Van Den Berg M & Theuns DA (2010b) Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients: is there more to it than meets the eye? Pacing and Clinical Electrophysiology 33, 1430–1436.
- Pedersen SS, Hoogwegt MT, Jordaens L & Theuns DA (2013) Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation. International Journal of Cardiology 166, 215–220.
- Rahman B, Macciocca I, Sahhar M, Kamberi S, Connell V & Duncan RE (2012) Adolescents with implantable cardioverter defibrillators: a patient and parent perspective. Pacing and Clinical Electrophysiology 35, 62–72.
- Sears SF, Todaro JF, Urizar G, Lewis TS, Sirois B, Wallace R, Sotile W, Curtis AB & Conti JB (2000) Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers. Pacing and Clinical Electrophysiology 23, 939–945.
- Sears SF Jr, Shea JB & Conti JB (2005) Cardiology patient page. How to respond to an implantable cardioverter-defibrillator shock. Circulation 111, 380–382.
- Senges-Becker JC, Klostermann M, Becker R, Bauer A, Siegler KE, Katus HA & Schoels W (2005) What is the “optimal” follow-up schedule for ICD patients? Europace 7, 319–326.
- Spindler H & Pedersen SS (2005) Posttraumatic stress disorder in the wake of heart disease: prevalence, risk factors, and future research directions. Psychosomatic Medicine 67, 715–723.
- Stewart MJ & Langille L (2000) A framework for social support assessment and intervention in the context of chronic conditions and caregiving. In Chronic Conditions and Caregiving in Canada: Social Support Strategies ( M Stewart ed.). University of Toronto Press, Toronto, pp. 3–28.
- Tung R, Zimetbaum P & Josephson ME (2008) A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. Journal of the American College of Cardiology 52, 1111–1121.
- Vazquez LD, Conti JB & Sears SF (2010) Female-specific education, management, and lifestyle enhancement for implantable cardioverter defibrillator patients: the FEMALE-ICD study. Pacing and Clinical Electrophysiology 33, 1131–1140.
- Weiss DS (2004) The Impact of Event Scale – Revised (2004). In Assessing Psychological Trauma and PTSD ( J Wilson & T Keane eds). Guilford, New York, NY, pp. 168–189.
- Weiss DS & Marmar CR (1997) The impact of event scale – revised 1997. In Assessing Psychological Trauma and PTSD ( J Wilson & T Keane eds). Guilford, New York , NY, pp. 344–362.
- Wikman A, Bhattacharyya M, Perkins-Porras L & Steptoe A (2008) Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome. Psychosomatic Medicine 70, 764–772.
- World Medical Association (WMA) (2004) The Declaration of Helsinki. Available at: http://www.wma.net/e/ethicsunit/helsinki.htm (accessed 1 October 2008).
Citing Literature
