Sex differences in predictors of illness intrusiveness 1 year after a cardiac event
Introduction
Quality of life issues following a cardiac event have been found to predict subsequent morbidity and mortality, independent of known prognostic factors [1]. Quality of life encompasses multiple aspects, ranging from strict consideration of physical symptoms to the inclusion of psychological states, as well as the degree of interference in a person's usual activities. It is the latter aspect of quality of life, namely illness intrusiveness, which is the focus of the current study.
Illness intrusiveness arises as a result of illness-induced lifestyle disruptions that interfere with involvement in valued activities [2], [3]. It represents a fundamental aspect of the psychosocial impact of chronic medical conditions and of quality of life and is explained not only by the physical impact of the illness but also by ones' psychological and social resources. The construct of illness intrusiveness has been validated in studies involving individuals with rheumatoid arthritis, end stage renal disease (ESRD), multiple sclerosis [3], [4], [5], [6], diabetes [7], laryngectomy [8], and breast cancer [9]. Differences in types of illness intrusiveness between patient groups have been documented, supporting the discriminant validity of the construct [2]. To date, illness intrusiveness, as measured by the Illness Intrusiveness Scale [2], has not been examined longitudinally in individuals following a cardiac event.
During the first 3 months following a traumatic event such as a cardiac event, one experiences decreased quality of life and increased psychological distress as part of an acute adjustment phase [10], [11], [12]. We have chosen to direct our attention to the longer term impact of a cardiac event on illness intrusiveness and therefore will review results of prospective studies only, pertaining to a period of at least 6 months duration following a cardiac event.
Prospective studies have examined predictors of various components of quality of life in individuals following a cardiac event. Poorer emotional quality of life at 6 months follow-up was predicted by poorer baseline emotional quality of life in patients with myocardial infarction (MI), and in patients with angina, by work disability, previous MI, smoker status, single status, and poorer baseline emotional quality of life [13]. In individuals with MIs, decreased social quality of life was predicted by baseline depressive and anxiety symptoms [14], smoking status, single status, having an MI prior to angina, and poorer emotional quality of life [13]. In individuals with angina, decreased social quality of life was predicted by poorer emotional quality of life [13]. In terms of constructs more closely related to illness intrusiveness, perceived decrease in leisure activities and subjective sense of “doing less” was predicted by baseline depressive and anxiety symptoms 1 year after having an MI [14]. Single status was not associated with poorer quality of life in patients with a history of ischemic heart disease 1 year after the cardiac event [11]. When evaluating the methodological quality of the above studies, it is important to note that in Mayou's (2000) [14] and Heller's (1997) [13] studies, level of physical symptomatology at follow-up was not controlled for, leaving open the possibility that follow-up level of distress was confounded with physical symptoms.
Sex differences in quality of life have been explored in only a few studies. One year after a cardiac event, women continued to report poorer quality of life in the areas of perceived general health [11] and psychological well-being as compared to men [11], [15]. Compared to normal controls, men reported significantly poorer quality of sexual life 1 year after a cardiac event, while this was not the case for women despite similar baseline characteristics [11]. Women also reported experiencing more somatic symptoms as compared to normal controls 1 year after a cardiac event while men did not [11]. As well, 1–2 years after an MI, women reported more days of reduced activity due to an impaired state of health than men did [16].
Sex differences in illness intrusiveness in cardiac patients have not been examined previously. Given that heart disease is a chronic medical condition, with known sex differences in general quality of life, it is important to examine potential sex differences in illness intrusiveness.
The first objective of this study was to examine sex differences in illness intrusiveness, a crucial aspect of quality of life, 1 year after an MI or unstable angina (UA). The second objective was to determine if there are any sex differences in predictors of illness intrusiveness, with predictors being measured at time of initial diagnosis and illness intrusiveness measured 1 year after the cardiac event. We investigated the predictive power of depressive symptomatology and indices of social support measured at the time of initial diagnosis while controlling for sociodemographic factors, risk factors for heart disease, and physical symptoms.
Section snippets
Procedure
A research nurse screened the admission record daily of the Coronary Intensive Care Unit (CICU) for patients admitted with a diagnosis of MI or UA. Medical information was collected for all patients admitted to the CICU with MI or UA to enable later comparisons between participants and nonparticipants. The research nurse approached patients for participation in the study using a standardized text. They did not approach patients in the following circumstances: if a patient was in a lot of pain,
Differences among baseline participants, refusers, and ineligible patients
Differences in demographic characteristics were examined among baseline participants, ineligible patients, and patients refusing to participate. There were no differences in sex distribution, admitting diagnosis distribution (MI vs. UA), or proportions of married/common-law, separated/divorced, and single individuals. Ineligible patients were significantly more likely to be widowed (Pearson χ2=16.20, P=.013) and older than participants (t=18.22, P<.001).
Sex differences in demographic and other
Discussion
One year after a cardiac event, men report more illness intrusiveness in their intimate life as compared to women, which is consistent with results of a previous study [11]. The overall absence of sex differences in the instrumental and Relationship/Personal Development Life domains stands in contrast to previous research in the general area of quality of life [16], [24], [25]. This may be due to the fact that many of the previous studies focused on physical status [11], [24] and psychological
Acknowledgements
We acknowledge the support of the Heart and Stroke Foundation of Canada for a research grant to investigate sex differences in patients following a cardiac event to Drs. Abbey, Stewart, Irvine, and Shnek. We wish to thank all the cardiac patients who generously participated in this study as well as the nurses and attending staff of the Toronto General Hospital Coronary Intensive Care Unit, University Health Network. This research was supported in part by the Canadian Institutes of Health
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