Anger, Anxiety, and Depression as Risk Factors for Cardiovascular Disease: The Problems and Implications of Overlapping Affective Dispositions
In this article, Suls and Bundle (2005) have identified 3 negative affective dispositions. They include anxiety, anger/hostility, and depression. The authors have further identified a link between these negative affective dispositions and cardiovascular diseases. As such, the objective of the study was to determine the effects of anger, anxiety, and depression on the development of cardiovascular diseases.
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Kop (1999) has distinguished between chronic physiological risk factors like anxiety and hostility and epidemiologic factors such a major depressive disorder. According to Kop (1999), chronic physiological risk factors can last for many years, while episodic factors only last for several months.
Carroll and colleagues (2002) opine that depression qualifies to be treated as an episodic risk factor. However, Suls and Bundle (2005) argue that because of its recurrent nature, some individuals are likely to possess a depressogenic disposition. What Suls and Bundle (2005) appear to suggest is that although anxiety and anger are mainly treated as clinical signs of depression, they might as well be treated as clinical symptoms of depression. Therefore, Suls and Bundle (2005) have decided to treat anxiety and anger as the conceptual symptoms of depression. Besides effective dispositions, fear, sadness, stressful events, and anger outburst can also cause a heart attack (Carroll et al., 2002).
In their article, Suls and Bundle are not mainly concerned with acute emotions, although they argue that emotional and stressful events can trigger Myocardial Infarction and other manifestations of heart disease. This is because effective dispositions increase the rate of occurrence of acute outbursts. For this reason, Sul and Bundle (2005) have decided to address the negative effects of measurement and construct overlap in causing cardiovascular heart diseases (CHD).
Cardiovascular heart diseases can be triggered by several biological factors and Suls and Bundle (2005) have examined them briefly. The article by Sul and Bundle (2005) is an attempt to critically analyze and summarize epidemiological studies relevant to the topic. Besides, the authors have also provided a vivid description of the biological, physiological, and behavioral pathways that eventually leads to the development of cardiovascular heart diseases. Suls and Bundle (2005) have then examined the psychometric evidence available in the literature on the measurement of the overlap of anxiety, anger, and depression. Moreover, Suls and Bundle (2005) have presented a very clear affect-disease pathway model that takes into account the aforementioned overlap. They have also discussed the effects of interpreting this epidemiological evidence.
By recognizing this overlap, it becomes easier to design more intricate affect-disease models. Also, the authors have tried to examine how best to enhance recognition of the overlap so that we can have a basis upon which future studies might explore the effects of emotions on cardiovascular disease. Being aware of this overlap is also important as we can then develop preventive measures in both behavioral and psychological medicine.
Myocardial infarction: survivors’ and spouses’ stress, coping, and support
There is enough evidence in the available literature to support the claim that the role of a spouse is crucial when his/her partner is recovering from myocardial infarction. On the other hand, hand, we have several other studies that have sought to determine the psychosocial factors affecting the spouses and survivors. In light of this, the current study by Stewart and colleagues (2000) is an attempt to determine the experiences of survivors of myocardial infarction and their spouses with stress, coping strategies, and social support. It is important to note that the current study mainly dwelt on first-time Myocardial Infarction cases, as opposed to recurrent cases. In this case, the researchers mainly emphasize the time of uncertainty and transition.
A total of 14 couples took part in the study. The research findings revealed that the lifestyle changes, emotional impact, reactions from partners, and encounters with various health professionals were similar for both spouses and survivors (Stewart et al., 2000).
Furthermore, Stewart and colleagues (2000) also noted that myocardial infarction survivors and their spouses utilized different types of strategies in a bid to cope with the various stresses associated with myocardial infarction. At the same time, myocardial infarction survivors and their spouses were both likely to seek relevant information from health care professionals. Also, myocardial infarction survivors and their spouses were involved in what the researchers called ‘protective buffering’ of their partners.
Couples talked of conflict, lack of support, and unfulfilled assistance as some of the factors affecting their relationships (Stewart et al., 2000). Survivors and spouses said that health professionals did not provide them with sufficient information and support.
Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure
Some studies have noted the crucial role played by social relationships in predicting the mortality and morbidity rates among patients diagnosed with coronary artery diseases (Krumholz et al, 1998). On the other hand, not much attention has been given to the importance of prognosis in offering support to elderly patients who have been admitted to the hospital with heart failure. In their study, Krumholz and colleagues (1998) were mainly interested in determining the importance of prognosis of emotional support since past studies had identified it as a key factor in offering emotional support to elderly patients admitted to a hospital after being diagnosed with acute myocardial infarction.
For this reason, the researchers were mainly concerned with assessing whether there is a link between emotional support and nonfatal/ fatal cardiovascular events among elderly patients receiving treatment for clinical heart failure.
In a bid to address this goal, the researchers integrated information from a community-based longitudinal study involving elderly patients. The study also included a detailed examination of psychosocial support, and a comprehensive follow-up exercise in case of adverse events (Krumholz et al, 1998). The authors also documented the patient’s hospitalization information after they had been diagnosed with heart failure by reviewing their medical records in detail.
A total of 292 subjects aged 65 years and above had their medical records reviewed. These patients had already been hospitalized after being diagnosed with clinical heart failure (Krumholz et al, 1998). The analysis revealed a strong link between high risk to nonfatal/ fatal cardiovascular outcomes during the first year and lack of emotional support, without adjusting for several relevant factors. However, even after adjusting for clinical severity, demographic factors, social ties, instrumental support, and functional status, lack of emotional support was still a leading risk factor. There was also a significant interaction between sex and emotional support.
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The researchers, therefore, concluded that the absence of emotional support among the hospitalized elderly patients diagnosed with heart failure acts as an independent and strong indicator of the occurrence of nonfatal/fatal cardiovascular events during the year of admission (Krumholz et al, 1998). The current cohort study had restricted this association with women.
Carroll, D., Ebrahim, S., Tilling, K., Macleod, J., & Smith, G. D. (2002). Admissions for myocardial infarction and World Cup football: Database survey. British Medical Journal, 325, 21–28.
Kop, W. J. (1999). Chronic and acute psychological risk factors for clinical Manifestations of coronary artery disease. Psychosomatic Medicine, 61, 476–487.
Krumholz, H. M. et al. (1998). Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure. Circulation, 97, 958-964.
Stewart, M., Davidson, K., Meade, D., Hirth, A., & Makrides, L. (2000). Myocardial infarction: survivors’ and spouses’ stress, coping, and support. Journal of Advanced Nursing, 31(6), 1351-1360.
Suls, J., & Bunde, J. (2005). Anger, Anxiety, and Depression as Risk Factors for Cardiovascular Disease: The Problems and Implications of Overlapping Affective Dispositions. The American Psychological Association, 131(2), 260–300.