School of Kinesiology and Health Science
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Browsing School of Kinesiology and Health Science by Subject "Anxiety"
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Item Open Access A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients(2011-07) Grewal, Keerat; Gravely-Witte, Shannon; Stewart, Donna Eileen; Grace, Sherry L.Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis, and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores, and recurrent events in CAD patients. One thousand two hundred and sixty eight CAD outpatients of 97 cardiologists were surveyed at two points. Recurrent events or hospitalization in the intervening 9 months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed, to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and investigate treatments is needed.Item Open Access Adult Congenital Heart Disease-Coping And REsilience (ACHD-CARE): Rationale and methodology of a pilot randomized controlled trial(Elsevier, 2015-11) Kovacsa, Adrienne H.; Irvine, Jane; Silversides, Candice K.; Nolan, Robert; Kentner, Amanda C.; Grace, Sherry; Bandyopadhyay, Mimi; Kovacs, Adrienne H.Background and Aim: As a result of significant advances in diagnosis and treatment, approximately 90% of infants born with congenital heart disease (CHD) are now expected to reach adulthood. However, an increased risk of cardiac sequelae necessitates lifelong cardiac surveillance and can significantly impact psychosocial development. One-third of North American adults with CHD have diagnosable mood or anxiety disorders and most do not receive appropriate mental health treatment. There are currently no published trials investigating psychological interventions for this unique patient population. It is thus important to establish the feasibility of conducting a psychological intervention trial in this population. In this methods paper, we describe (1) the development of a group psychosocial intervention aimed at improving the psychosocial functioning, quality of life, and resilience of adults with CHD, and (2) the design of a study to determine the feasibility of a future full-scale randomized controlled trial. Methods: Based upon quantitative and qualitative (focus group) research, we developed an 8-session Adult CHD–Coping And REsilience (ACHD-CARE) Program. We subsequently designed a 2-parallel arm non-blinded pilot randomized trial with a 1:1 individual patient allocation ratio. Inclusion criteria are documented CHD, age >18 years, English-language proficiency, no planned surgery, and clinically-elevated score (i.e., >8) on the Hospital Anxiety and Depression Scale depression (HADS-D) or anxiety (HADS-A) subscale. Exclusion criteria are current psychotherapy, reported suicidal intent, or significant cognitive impairment, psychosis, or personality disorder. Patients from a single tertiary centre are randomized to the ACHD-CARE intervention or Usual Care. The intervention is delivered during 90-minute sessions held weekly in small groups. Feasibility is assessed in the following five domains:(i) process (e.g., participant recruitment and retention), (ii) resources, (iii) management, (iv)scientific outcomes, and (v) acceptability of the intervention. Results: Our initial experiences indicate that the study design is feasible and acceptable to stakeholders. We have been able to successfully recruit and retain participants, although travel distance and competing time demands are barriers for many potential study participants. There have been no insurmountable challenges in study management. At the conclusion of the study, we will be poised to make one of three determinations: (1) a full-scale RCT is feasible, (2) a full-scale RCT is feasible with modifications, or (3) a full-scale RCT is not feasible. Conclusions: This study underscores the importance of carefully developing and testing the feasibility of psychosocial interventions in medical populations before moving to full-scale clinical trials. Feasibility outcomes from this study will guide the future evaluation and provision of psychological treatment for adults with CHD.