Depression, Recurrence, and Perceptions of Physical Fitness among CHD Patients: A Comparison based on Participation in Phase II Cardiac Rehabilitation Program

Abstract

Coronary heart disease (CHD) patients experience various physical and psychological changes after an acute attack. Depression has been identified as a substantive psychological problem in CHD patients. Cardiac rehabilitation (CR) intends to restore optimal physical and psychological condition of the patients. However, less attention is bestowed towards the psychological aspect of CR. Research on the effects of CR on patient psychological problems has not been discussed in many studies in Indonesia. This study aimed to compare depression, recurrence, and fitness levels among CHD patients based on participation in Phase II CR Program. This research used a quantitative comparative method involving 66 CHD patients recruited by a purposive sampling technique. After applying the selection criteria for this study, the patients were assigned to the CR group (nCR=29) and the non-CR group (nNCR=37). Data were collected using the Beck Depression Inventory-II (BDI II) and instruments developed by researchers to measure recurrence and fitness levels. Data were analyzed using frequency distribution, chi-squared, and Mann-Whitney tests. Depression experienced by CHD patients in both groups with mean in non-CR and CR groups of 11.11 (± 7.8) and 8.59 (± 6.5), respectively. There was no significant difference in depression level among the groups (p>0.05)). Meanwhile, as many as 45% of the patients in the CR group and 22% in the non-CR group had never experienced chest pain (recurrence) within the past month. In addition, the physical fitness was perceived increased by 90% of the patients in the CR group and 0% in the non-CR group. It was also found that there were significant differences in the recurrence and physical fitness among the two groups (p <0.05). Patients participating in Phase II CR program had a better perception of physical fitness and a lower frequency of chest pain than patients in the non-CR group. Although the depression level in patients in the two groups did not differ significantly, patients in the non-CR group scored higher in depression. Accordingly, assessment and psychosocial interventions need to be improved to optimize CR program services.

Self-Efficacy in Self-Care and Its Related Factors Among Patients with Coronary Heart Disease in Indonesia: A Rasch Analysis

“…The duration of being diagnosed with CHD can be associated with a good recovery process and the treatment carried out, especially for those undergoing reperfusion therapy or cardiac rehabilitation. 50 Previous studies also stated that patients undergoing treatment at the High Care Unit (HCU) have higher level of helplessness and lower perceived benefits and acceptance than patients undergoing outpatient care. 51 This condition shows that the patient’s adaptation to the disease is not yet optimal because the physical condition is still weak after experiencing an acute heart attack.…”

Efficacy of Cognitive Behavior Therapy in Reducing Depression among Patients with Coronary Heart Disease: An Updated Systematic Review and Meta-Analysis of RCTs

“…This condition may occur along with improving physical and psychosocial conditions following CHD. Patients with early-stage CHD can experience a high degree of helplessness after an acute attack, which is significantly associated with depression [ 49 , 50 ]. Notably, the helplessness gradually decreases after the patient’s condition improves, mainly through cardiac rehabilitation [ 51 ].…”

Illness cognition and depression among patients with coronary heart disease

“…One of the efforts to reduce helplessness is through increasing physical function. Moreover, improving physical function in CHD patients can be achieved through cardiac rehabilitation (Sutantri et al, 2019;Nuraeni et al, 2020;Su et al, 2020). However, those interventions still require further investigation of their influence on reducing helplessness among CHD patients in Indonesia.…”

“…However, this psychological problem is still not optimally managed. Some studies indicated the failure of interventions for CHD patients to effectively deal with psychological issues such as anxiety and depression compared to physical problems after an acute condition (Su & Yu, 2019;Nuraeni et al, 2020;Turan Kavradim et al, 2020). In accordance, nurses as care providers have a role in providing holistic nursing care, including physical, psychological, and spiritual aspects.…”