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SPECIAL ISSUE: COMORBIDITY STUDIES |
From the Faculty of Nursing (S.C.) and the Department of Psychiatry (N.F.-S., F.L.), University of Montreal; the Research Center, Montreal Heart Institute (S.C., N.F.-S., F.L.); and the Department of Psychiatry (N.F.-S, F.L.) and School of Nursing (N.F.-S.), McGill University, Montreal, Canada.
Address reprint requests to: Sylvie Cossette, Montreal Heart Institute Research Center, 5000 Belanger St. E., Montreal, QC, Canada, H1T 1C8. Email: cossets{at}scinf.umontreal.ca
OBJECTIVE: The objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post–myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions (the Montreal Heart Attack Readjustment Trial [M-HART]). Gender differences were considered.
METHODS: We studied 433 patients (36.0% women) from the M-HART treatment group who received two home visits after achieving a high psychological distress score (ie, 
5) on the General Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (<5) or a reduction of 50% after the two visits. Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success, 1-year death and readmission rates, and 1-year depression and anxiety symptoms.
RESULTS: Patients with short-term GHQ success were more likely to show mid-term GHQ success (p < .001), marginally less likely to die of any causes (p = .087), less likely to die of cardiac causes (p = .043), less likely to be readmitted for any reason (p < .001) and for cardiac reasons (p < .001), and less likely to have high depression (p < .001) and anxiety (p < .001) at 1-year than patients with short-term unsuccessful GHQ outcomes. Results held for men and women and were not altered by controlling for potential confounders. However, the number of deaths prevented analysis with statistical controls.
CONCLUSIONS: Post–myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women.
Key Words: myocardial infarction • psychosocial interventions • psychological distress • mortality • readmissions.
Abbreviations: BDI = Beck Depression Inventory; CI = confidence interval; GHQ = General Health Questionnaire; ICDA = International Classification of Diseases, Adapted; LVEF = left ventricular ejection fraction; M-HART = Montreal Heart Attack Readjustment Trial; MI = myocardial infarction; OR = odds ratio; PSSS = Perceived Social Support Scale; S-STAI = State Scale of the State-Trait Anxiety Inventory.
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