Volume 25, Issue 2 p. 305-323
Original Article

Psychosocial markers of pre-hospital decision delay and psychological distress in acute coronary syndrome patients

Mercedes Arrebola-Moreno

Mercedes Arrebola-Moreno

Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain

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Dafina Petrova

Corresponding Author

Dafina Petrova

Escuela Andaluza de Salud Pública, Granada, Spain

Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Spain

CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain

Correspondence should be addressed to Dafina Petrova, Andalusian School of Public Health, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Granada, Spain (email: [email protected]).

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Dunia Garrido

Dunia Garrido

Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain

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José Antonio Ramírez-Hernández

José Antonio Ramírez-Hernández

Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Spain

Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain

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Andrés Catena

Andrés Catena

Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain

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Rocio Garcia-Retamero

Rocio Garcia-Retamero

Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain

Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany

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First published: 17 February 2020
Citations: 14

Abstract

Objectives

Both pre-hospital decision delay – the time patients wait before seeking medical attention after symptoms have started – and high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors.

Design

A cross-sectional study of 102 consecutive, clinically stable ACS survivors.

Methods

Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted.

Results

Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables.

Conclusions

Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients’ mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one’s family) but not about social concerns (e.g., wasting other people’s time) during the cardiac episode.

Statement of Contribution

What is already known on this subject?
  • Longer pre-hospital decision delay, that is waiting longer to seek medical attention after symptoms have started, predicts poor prognosis of acute coronary syndrome patients.
  • High psychological distress post-ACS, such as the development of anxiety and/or depression, also predicts poor prognosis of these patients.
What does this study adds?
  • This study identifies several psychosocial markers of longer prehospital decision delay and high psychological distress post-ACS.
  • Prehospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one’s family) but not about social concerns (e.g., wasting other people’s time) during the cardiac episode.
  • Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress, and these relationships were mediated by longer prehospital decision delay.
  • Resilience was related to lower psychological distress post-ACS.

Conflicts of interest

The authors declare no conflicts of interest.

Data availability statement

This research is part of project ‘PySCA: Study on the impact of psychological factors in acute coronary syndrome’ (Principal Investigator: JARH). Individualized data from the project cannot be publically shared on a data repository due to the conditions of non-disclosure described in the hospital consent form signed by the participating patients. Interested researchers are encouraged to contact the corresponding author.