Uticaj dimenzija ličnosti na kardiovaskularnu reaktivnost kod pacijenata sa dijagnozom koronarne bolesti

Abstract

UVOD: Jedna od mera stresne reakcije zdravih i obolelih osoba od koronarne bolesti je kardiovaskularna reaktivnost koja se definiše kao promena veličine kardiovaskularnih parametara (npr. puls, sistolni pritisak) tokom izlaganja fizičkom ili psihološkom stresoru, u odnosu na njihove vrednosti u stanju mirovanja. Na kardiovaskularna reaktivnost utiču mnogobrojni činioci kao što su genetska predispozicija, pol, životno doba, vrste stresora, strategije prevladavanja stresa, aktuelno raspoloženje, itd. Primenom različitih inventara ličnosti potvrđeno je da i pojedine dimenzije ličnosti značajno dorinose individualnim razlikama kardiovaskularne reaktivnosti na stres. CILJ: Glavni cilj našeg istraživanja bio je da se ispita uticaj opštih dimenzija ličnosti i Tipa D ličnosti na kardiovaskularnu reaktivnost kod pacijenata sa dijagnozom koronarne bolesti, uzimajući u obzir potvrđene moderatore (pol, depresivnost, stilovi prevladavanja stresa). METOD: Uzorak je činilo je 100 ispitanika izabranih metodom prigodnog uzorkovanja, podeljenih u dve grupe: a) studijska grupa (n=79) kojom su obuhvaćeni pacijenati sa dijagnozom stabilne koronarne bolesti i b) kontrolna grupa zdravih ispitanika (n=21) odgovarajućih sociodemografskih karakteristika. Istraživanje je sprovedeno u periodu od 2001. do 2007. godine u Klinici za kardiovaskularne bolesti KCS. Kod svih ispitanika izveden je mentalni stres test kombinovan sa testom fizičkim opterećenjem, u saradnji sa kardiologom, što je praćeno i ehokardiografski. Eksperimentalna faza istraživanja. Mentalni stres test kombinovan sa testom fizičkim opterećenjem izvođen je kod svih ispitanika u podne (1200h), u kontrolisanim klimatskim uslovima. Test se sastojao iz tri faze: a) psihijatrijski interviju, neposredno pre eksperimenta; b) faza odmora: u tihoj i delimično zamračenoj prostoriji ergo-kabineta ispitanik se 10-15 minuta odmarao u ležećem položaju; c) test mentalnog stresa koji obuhvata dva zadatka: usmeno računanje i zadatak koji reaktivira ljutnju. Instrumenti procene. Prvo je sproveden polustrukturisani intervju u cilju prikupljanja podataka relevantnih za istraživanje (sociodemografske karakteristike, faktori rizika za koronarnu bolest). Nakon laboratorijskog testa i psihijatrijskog intervjua, svi ispitanici popunili su bateriju testova koja je uključivala sledeće instrumente: a) Revidiran nov upitnik ličnosti, forma S (NEO Personality Inventory - Revised, NEO-PI-R) za pocenu dimenzija ličnosti; b) Skala D14 (The D-Scale 14, DS-14) za procenu komponenti distres ličnosti - Negativni afektivitet i Socijalna inhibicija; c) Upitnik o stilovima prevladavanja stresa (Ways of Coping Questionnaire - WCQ-R); d) Bekova skala za procenu depresije (Beck Depression Inventory - BDI)...

Introduction: Over the past few decades, cardiovascular reactivity (CVR) has come to be viewed as a meassure of the stress reaction in patients with coronary heart disease as well as in healthy subjects. CVR is defined as a change of the measures of cardiovascular activity (i.e. heart rate, blood pressure) during exposure to physical or psychological stress, comparing to their values in the rest state. Many factors might contribute to the individual differences in CVR, such as genetic predisposition, gender, age, types of stressors, way of coping, affectivity, etc. Furthermore, many studies confirmed that specific personality dimensions play a significant role in the indivdual differences in CVR. Purpose: The main purpose of our investigation was to examine the effects of personality dimensions on cardiovascular reactivity (CVR) to experimentally induced stress, taking into account the confounding variables (i.e. gender, depression, and coping with stress). Methodology: The sample consisted of non-consecutive case series of seventy nine patients with clinically stable and angiographically confirmed coronary artery disease (CAD) who had been admitted to the Clinic of Cardiology, University Clinical Centre, and twenty one healthy persons of the control group. The participants were included in the study during the period of six years (from 2001 to 2007). The test was conducted in three phases: a) Initial psychiatric assessment; b) Rest phase: participants rested in a lying position for 10-15 minutes in a partially darkened room; c) Application of the Mental stress test (MST) that consists of two tasks: mental arithmetic and an anger recall task. Continuous 12-lead ECG and blood pressure were monitored and recorded every 5 minutes throughout the rest and the MST procedure. Afterwards, all participants were administered the following battery of psychological tests: a) NEO Personality Inventory - Revised, NEO-PI-R); b) The D-Scale 14, DS-14; c) Ways of Coping Questionnaire - WCQ-R; and d) Beck Depression Inventory - BDI. Results: The results of the study showed that patients with coronary heart disease scored higher than healthy controls on Neuroticism and lower on Extraversion and Openness to Experience. There were no statistically significant differences on Agreeableness and Conscientiousness. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in the healthy control group. The mean NA/SI scores, also, were higher in patients with stable coronary heart disease than in the healthy control group. Neuroticism and Extraversion shared about 48% and 38% variance with Negative affectivity and Social inhibition, respectively. Correlation analyses indicated that both Type D dimensions (NA, SI) were positively associated with Neuroticism, while negatively associated with Extraversion and Conscientiousness. In addition, we found negative correlation between Negative affectivity and Agreeableness, as well as, negative correlation between Social inhibition and Openness to Experience...