|Year : 2012 | Volume
| Issue : 3 | Page : 136-140
Assessment of the level of stress and coping strategies among patients with coronary artery disease
Madisetty Bhagyalakshmi1, Banda Venkata Ramana1, Hema Suresh2, Jaya Mohan Raj3
1 Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Meenaakshi College of Nursing Chennai, India
3 SRM College of Nursing, Department of Community Health Nursing Chennai, India
|Date of Web Publication||11-Jan-2013|
Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Stress evolves out of life events and experiences, stimulates one's thinking process and helps to maintain a basal level of autonomic arousal. Stress and certain behaviors like aggressiveness striving for achievement contribute to the pathogenesis of Coronary Artery Disease (CAD). Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction. Coping processes are usually involved to reduce stress levels. Objectives: The study was conducted to assess the stress level and coping strategies among the CAD patients. Materials and Methods: Non experimental research design was chosen. The patients with CAD admitted for the first time were taken as the samples. A total of 100 patients were selected by non-probability sampling methods. The standardized tool used for the study consisted of stress and coping scale. The questionnaire consisted of 20 questions to assess stress and 20 questions to assess coping. The maximum score indicated increased stress and adequate coping and the minimum score indicated less stress and inadequate coping. Results: In this study 43% of the patients were having moderate stress and 91% of patients showed moderate coping. None had increased stress and only 5% of the patients had adequate coping strategy. Conclusions : This study demonstrated an approach to develop more coping strategies to reduce stress among the CAD patients. Nurses working in the Cardiology Department should engage themselves to address the psychosocial needs of those patients and take measures to plan coping strategies.
Keywords: Coping, coronary heart disease, stress
|How to cite this article:|
Bhagyalakshmi M, Ramana BV, Suresh H, Raj JM. Assessment of the level of stress and coping strategies among patients with coronary artery disease. J Sci Soc 2012;39:136-40
|How to cite this URL:|
Bhagyalakshmi M, Ramana BV, Suresh H, Raj JM. Assessment of the level of stress and coping strategies among patients with coronary artery disease. J Sci Soc [serial online] 2012 [cited 2020 Jun 4];39:136-40. Available from: http://www.jscisociety.com/text.asp?2012/39/3/136/105918
| Introduction|| |
Stress is a universal part of the human experience and is necessary for survival. It affects every person regardless of age, gender, race, economic condition, or educational level. Stress evolves out of life events and experiences, which stimulates ones thinking process and helps to maintain a basal level of autonomic arousal. Studies indicate that psychiatric disorders frequently occur as complications or co-morbid conditions in persons with cardiovascular disease, like depression, anxiety, delirium and cognitive disorders.
Coronary Artery Disease (CAD) is the leading cause of death in the United States and most of the industrialized world. About one third of all adults over age 35 will ultimately die of cardiovascular diseases, among the patients with newly diagnosed CAD, one-sixth of the sample meet the criteria for major stress and depression; at 1-year follow-up, only one-sixth of those who were depressed had received treatment. 
It is believed that stress and certain behaviors like competitive striving for achievement, exaggerated sense of time urgency, aggressiveness and hostility contributes to the pathogenesis of CAD. Stress predicted the worsening of heart failure symptoms, physical and social functioning, and quality of life. Symptoms of distress were the strongest predictor of decline in health status.  Presence of psychosocial stressors is associated with increased risk of acute MI, suggesting that approaches aimed at modifying the risk factors should be developed. , Psychosocial risk factors such as depression, stress and socio-economic disadvantages are associated with increased morbidity and mortality from CAD in older patients, daily life events trigger myocardial ischemia in CAD patients.
Patients with acute MI report a higher subjective mental stress during 2-4 weeks preceding the acute coronary event. Psychosocial therapy reduces the risk of cardio vascular death in sudden cardiac arrest survivors. Behavioral coping may improve wellbeing of patients with heart failure. 
| Materials and Methods|| |
The study was conducted in cardiology intensive care unit at a tertiary care hospital. A sample of 100 patients with CAD who were admitted in ICCU of Cardiology Department was included in the study. Sampling technique used by the investigator is Non probability convenient sampling. This method was chosen so as to achieve the desired sample size during the data collection period.
The instrument used for data collection was a standardized stress and coping scale. This was selected based on the objectives of the study and through review of literature. The tool used for the study consists of two parts. Part-I Demographic data includes age, sex, educational status, residence, family income per month, family system and occupation. Part-II Stress and coping scale. A standardized scale was used to assess the stress and coping strategies among the CAD patients. Total number of items for stress was 20 and coping strategies was 20. The rating scale ranged from 1 to 4 which were characterized as never, sometimes, very often and always. The major portion of the items were adopted from Lazarus and Hassles Scale (1981) related to stress and coping which was a standardized tool used to assess the level of stress and coping among normal individuals in day to day life. 
Total items of the questionnaire of stress are 20 and total items of questionnaire of coping strategies are 20. A four point Likert scale was used and the responses were never - 1, sometimes - 2, very often - 3, always - 4. The total score of each was 80. The total score reflect the level of stress and coping among the patients. The maximum score indicates increased stress and adequate coping. The minimum score indicates less stress and inadequate coping. The scores were categorized as follows. Below 50%-Increased stress and inadequate coping, 51% to 75%-Moderate stress and moderate coping Above 76%-less stress and adequate coping. 
| Results|| |
Regarding the age of CAD patients 26 (26%) were above 60 years, 24 (24%) were between 40 years to 49 years, 22 (22%) were between 50 years to 59 years and 28 (28%) of the patients are less than 40 years. Out of 100 CAD patients 49 (49%) of the patients were males and 51 (51%) are females. Regarding the occupation of CAD patients 44 (44%) of the patients were unemployed and 13 (13%) were government employed. Among the CAD patients 75 (75%) of the patients are from urban/semi urban areas, and 25 (25%) were in rural areas.
Overall the 57 (57%) patients had less stress, 43 (43%) patients had moderate stress and none of them had the increased level of stress. It is seen that 91% of the patients with Coronary Artery Disease had moderate coping, 5 (5%) had adequate coping and 4 (4%) had inadequate coping strategy. There is statistical significant P = 0.001 (P < 0.005) positive moderate correlation between level of stress and level of coping ability of CAD patients. [Table 1] There was a statistically significant association between CAD patients stress with their sex, occupation and family income and there was no statistical significant association with age, education, family system and residence. [Table 2] There was a statistically significant association between CAD and coping with their sex and residence and there was no statistical significant association with age, education, occupation, family income and family system. Females had more moderate coping strategies than male samples. Samples belong to urban area had moderate coping than suburban and rural area. [Table 3]
|Table 1: Level of stress and coping strategies and their correlation N=100 |
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|Table 2: Association of the level of stress among patients with coronary artery diseasewith their demographic variables |
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|Table 3: Association between coping strategies of patients with coronary artery disease with their demographic variables N=100 |
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| Discussion|| |
The research study was done to assess the level of stress and coping strategies among the CAD patients. The study was done with 100 patients with CAD in Cardiology Department at a tertiary care hospital. A total number of 100 patients with CAD were selected using convenient sampling technique. Stress and coping was assessed by using intervention tool. Out of 100 patients females were 51 (51%) and males were 49 (49%).
In this study the first objective is to assess the level of stress among patients with CAD. It shows that 57 (57%) of patients had less stress, 43 (43%) of patients had moderate stress and none of the patients had increased level of stress. The findings of the study were correlated with the study conducted by Chockalingam A et al. (2003) as the patients with acute MI report a higher subjective mental stress during 2 to 4 weeks preceding the acute coronary event.  The second objective of this study was to assess the level of coping strategies used by the patients with CAD. It shows that 91 (91%) of the patients in the moderate coping strategy, 5% were adequate coping and 4% were inadequate coping strategies. The findings of the study were correlated with the study conducted by Cowan Marie J (2001) as the risk of cardiovascular death was significantly reduced 86% by psychosocial therapy, cognitive behavioral therapy aimed at self-management and coping strategies for depression anxiety and anger and cardiovascular health education. 
The third objective of this study was to correlate the level of stress and coping strategies among CAD. Our study shows that there was a statistically significant positive moderate correlation between level of stress and level of coping ability (P = 0.05). The findings of this study were correlated with the study of Yu DS et al. (2004) showed that there is high level of psychological distress poor perceived emotional informational support with CAD were identified as the significant correlates of psychological distress, and to have a positive health perception and social support are the treatment goals.  The fourth objective of this study was to associate the level of stress and coping strategies with their demographic variables. It shows that there was a statistically significant association of stress with sex, occupation and family income of the patient with CAD. There was no significant association with age, education, family system and residence.
Our study revealed that there was a statistical significant association of coping strategies with sex and residence, but no statistical significant association with age, education, occupation, family system and family income. The findings of the study were correlated with the study conducted by Brunett et al. (2004) which showed that the patients who had moderate income, low social support, prolonged period following a diagnosis of CAD had moderate stress.  This study showed that 43 (43%) of patients had moderate stress and 91 (91%) of patients had moderate coping strategies. So there is necessity to improve the knowledge regarding prevention of CAD, stress management techniques and counseling sessions to the patients with CAD.
| Conclusions|| |
In this study 43% of the patients were having moderate stress and 91% had moderate coping. None had increased stress and only 5% of the patients had adequate coping strategy. In this study it was observed that as level of stress increased coping strategies also increased. This study suggests developing more coping strategies to reduce stress among the CAD patients. Therefore nurses have the responsibility to conduct programs like health education, stress reduction techniques and counseling sessions to overcome the stress. Several coping mechanisms including crying, sleeping, eating, yawning, laughing, physical exercise and day dreaming should be encouraged to reduce the stress.
| References|| |
|1.||Hanser SB, Mandel SE. The effects of music therapy in cardiac health care. Cardiol Rev 2005;13:18-23. |
|2.||Tak YR, McCubbin M. Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease. J Adv Nurs 2002;39:190-8. |
|3.||Welin C, Lappas G, Withelmsen L. Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease. J Intern Med 2000;247:629-39. |
|4.||Pedersen SS, van Domburg RT, Larsen ML. The effect of low social support on short-term prognosis in patients following a first myocardial infarction. Scand J Psychol 2004;45:313-8. |
|5.||Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13, 648 control from 52 countreies (the INTERHEART study): Case-control study. Lancet 2004;364:953-62. |
|6.||Vukovic DS, Krotin ME, Babic MM, Zivanovic BM. Anxiety level and responses to stress caused by air raids among patients with ischemic heart disease. Prehosp Disaster Med 2005;20:249-52. |
|7.||Shemesh E, Yehuda R, Milo O, Dinur I, Rudnick A, Vered Z, et al. Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction. Psychosom Med 2004;66:521-6. |
|8.||Chockalingam A, Venkatesan S, Dorairajan S, Moorthy C, Chockalingam V, Subramaniam T. Estimation of subjective stress in Acute Myocardial Infarction. J Postgrad Med 2003;49:207-10. |
|9.||Yu DS, Lee DT, Woo J, Thompson DR. Correlates of psychological distress in elderly patients with congestive heart failure. J Psychosom Res 2004;57:573-81. |
|10.||Brummett BH, Barefoot JC, Siegler IC, Clapp-Channing NE, Lytle BL, Bosworth HB, et al. "Characterstics of socially isolated patients with Coronary Artery Diseasewho are at elevated risk for mortality". Psychosom Med 2001;63:267-72. |
[Table 1], [Table 2], [Table 3]