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Long-Term Survival Differences Among Low-Anxious, High-Anxious and Repressive Copers Enrolled in the Montreal Heart Attack Readjustment Trial

From the Department of Psychiatry (N.F.-S., F.L.) and School of Nursing (N.F.-S.), McGill University; the Research Center, Montreal Heart Institute (N.F.-S., F.L., G.G., A.M., M. J., M.G.B.); the Departments of Psychiatry (N.F.-S., F.L.) and Medicine (M. J., M.G.B.), University of Montreal; and the Research Center, Centre Hospitalier de l’Université de Montréal (N.F.-S., F.L.), Montreal, Canada.

Address reprint requests to: Nancy Frasure-Smith, PhD, Montreal Heart Institute Research Center, 5000 Bélanger St. E., Montreal, QC, Canada, H1T 1C8. Email: frsm{at}icm.umontreal.ca

OBJECTIVE: This study reports 5-year outcomes from the Montreal Heart Attack Readjustment Trial, a randomized, controlled trial of monthly telephone monitoring of psychological distress and home nursing visits in a sample of 1376 patients. It focuses on differences in long-term program impact associated with patients’ sex and baseline anxiety/repressor coping styles. The potential mediating roles of medications, medical care utilization, and changes in negative emotions over the program are also explored.

METHODS: Three subgroups were defined using median splits on the State Anxiety Inventory and Marlowe-Crowne Scale administered at baseline: truly low anxious, repressors, and high anxious. Quebec medicare data were used to track survival through 5 years.

RESULTS: The trend toward worse prognosis in women in the treatment group and no evidence of treatment impact in men that were seen during the program year were maintained during the follow-up. Analysis of results in terms of coping styles showed a significant long-term survival benefit of treatment in highly anxious men, for whom reductions in somatic symptoms of depression mediated program impact. However, the program was also associated with significantly worse survival in repressors of both sexes. By the end of the program, repressors in the treatment group were more likely to be prescribed benzodiazepines and to have visited emergency rooms without being readmitted than those in the control group, suggesting that the program may have increased distress in repressors.

CONCLUSIONS: Patients’ coping style is important in determining outcomes of psychosocial treatments and should be taken into account when tailoring interventions.

Key Words: myocardial infarction • psychosocial intervention • mortality • repressor • anxiety

Abbreviations: ACE = angiotensin converting enzyme; BDI = Beck Depression Inventory; GHQ = General Health Questionnaire; MC = Marlowe-Crowne Social Desirability Scale; M-HART = Montreal Heart Attack readjustment Trial; MI = myocardial infarction; PSSS = Perceived Social Support Scale; S-STAI = Spielberger State Anxiety Inventory

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