Study of the dynamics of psychological factors in patients with coronary heart disease after coronary artery bypass surgery

   Relevance. Nowadays cardiovascular diseases are the leading cause of prevalence and mortality. One of the most common cardiovascular diseases is coronary heart disease (CHD). Contemporary treatment for CHD includes both pharmacotherapeutic and cardio-surgical methods. It is well-established that psychological factors contribute to the etiopathogenesis of the disease and can influence its course and prognosis. To plan and improve psychological rehabilitation measures, it is crucial to identify the specific psychological characteristics and their dynamics in the postoperative period. Traditionally, studies on patients’ psychological characteristics are conducted during the inpatient treatment period and are focused on identifying the intensity and dynamics of specific indicators (such as anxiety, depression, coping behavior, personality traits, etc.). However, for a comprehensive understanding of the manifestations of the complex of studied characteristics, their interrelationships, and changes at different stages of treatment and rehabilitation, an approach involving the study of the factor dynamics of psychological indicators is of interest.

   The aim of the study is to identify the dynamics of psychological factors based on a set of psychological characteristics (including psychoemotional and cognitive aspects, coping behavior, and quality of life) in patients with coronary heart disease (CHD) after coronary artery bypass grafting (CABG).

   Methods. A total of 254 patients with CHD undergoing CABG were assessed. The study consisted of three stages: 1) preoperative assessment, 2) postoperative assessment during the inpatient treatment, and 3) evaluation three months after the surgery. The clinical-psychological approach and the following psychodiagnostic methods were used: The Trail-Making Test (TMT), Luria´s Memory Words Test, Integrative Anxiety Test, Asthenic State Scale modified by L.D. Malkova and T.G. Chertova, the Symptom Checklist-90-Revised (SCL-90-R), The Ways of Coping Questionnaire (WCQ) by Lazarus and Folkman, 36-Item Short Form Survey (SF-36), and the Big Five Personality Test.

   Results and Analysis: Factor analysis of the obtained data was conducted, and factor dynamics were examined. The factor “Psychopathological Manifestations and Impairment of Memory and Attention” is characterized by a slight increase at the second stage and a decrease at the final stage of the study. The factor “Anxiety-Phobic Manifestations” shows a decreasing trend at the second stage and a significant increase at the third stage. The factor “Coping with Difficulties Orientation” demonstrates a clear and consistent decrease from the first stage to the third stage of the study. The factor “Reduced Quality of Life and Unsatisfactory Somatic Condition” shows a significant increase in intensity by the second stage of the study and a decline by the third stage. The factor “Neurotic Manifestations of an Anxious-Rumination Type” is most pronounced at the first stage, experiences a decrease by the second stage, and rises again by the third stage. The factor “Asthenic Manifestations in the Context of Aggressive Tendencies” is not characterized by pronounced dynamics (noted only a slight increase in intensity at the second stage and a gradual decrease at the third stage).

   Conclusion. Six psychological factors were identified based on the studied psychological characteristics. The study of factor dynamics yielded practical significance. Specifically, for the planning of psychological rehabilitation, it is noteworthy that there was a significant increase in the intensity of the “Anxiety-Phobic Manifestations” factor at the third stage of the study (exceeding preoperative levels). The consistent decrease in the “Coping with Difficulties Orientation” factor (from the first to the second stage and from the second to the third stage) is also relevant. These findings should be considered in the rehabilitation process for patients with coronary heart disease after coronary artery bypass grafting.

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