Skip to main content
SpringerLink
Log in

Assessment of the need for psychosomatic care in patients with suspected cardiac disease

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Objective

The study aimed to assess the subjectively perceived need for additional general disease-oriented and psychotherapeutic care in patients with suspected cardiac disease and to investigate if the request for additional care is consistent with impairment of generic quality of life and the presence of psychosomatic risk factors.

Material and methods

Patients referred for cardiac stress testing because of suspected cardiac disease completed the assessment of the demand for additional psychological treatment (ADAPT) questionnaire, an assessment tool for counselling demand in patients with chronic illness, the SF-36 quality of life and the hospital anxiety and depression scale (HADS) questionnaires.

Results

The questionnaires were administered to 233 patients (age: 54.5 ± 13.4, 57.5 % male). Exclusive demand for disease-oriented counselling was indicated by 45.1 %, demand for psychotherapeutic counselling (exclusive or combined with disease-oriented demand) by 33.9 %. Almost all patients with psychotherapeutic demand (96.3 %) expressed also request for disease-oriented counselling. Patients with exclusive demand for disease-oriented counselling showed significantly lower scores in the emotional and physical functioning and role domains of the SF-36 than the norm population. Patients demanding psychotherapeutic counselling reported significantly lower scores in all SF-36 domains than the norm population. Psychotherapeutic demand was strongly associated with positive indicators for mental distress: SF-36 MH (OR: 4.1), SF-36 MCS (OR: 5.9), HADS anxiety (OR: 3.9), and HADS depression (OR: 3.0).

Conclusions

Our study shows that the patients’ request for additional care reflects impairment of generic health status and psychological risk load. This indicates that the assessment of subjectively perceived demand allows to screen for patients who are in need of psychosomatic care and motivated to participate in additional counselling and therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CAD:

Coronary artery disease

ADAPT:

Assessment of the demand for additional psychological treatment questionnaire

VAS:

Visual analogue scale

PCA:

Principal component analysis

SF-36:

Short form 36 generic health questionnaire

PCS:

Physical component summary of the SF-36

MCS:

Mental component summary of the SF-36

MH:

Mental health domain of the SF-36

HADS:

Hospital anxiety and depression scale

QOL:

Quality of life

References

  1. Strike P, Steptoe A. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis. 2004;46(4):337–47.

    Article  PubMed  Google Scholar 

  2. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med. 2002;2(3):267–314.

    Article  PubMed  Google Scholar 

  3. Neylon A, Canniffe C, Anand S, et al. A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis. 2013;55(6):574–81.

    Article  PubMed  Google Scholar 

  4. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J. 2007;28(19):2375–414.

    Article  PubMed  Google Scholar 

  5. Lichtman JH, Bigger JT, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association. Circulation. 2008;118(17):1768–75.

    Article  PubMed  Google Scholar 

  6. Ladwig K‑H, Lederbogen F, Albus C, et al. Positionspapier zur Bedeutung psychosozialer Faktoren in der Kardiologie. Kardiologe. 2013;7(1):7–27.

    Article  Google Scholar 

  7. Engel G. The Need for a new medical model: A Challenge to Biomedicine. Science (80- ). 1977;196(4286):129–36.

    Article  CAS  Google Scholar 

  8. Adler RH. Engel’s biopsychosocial model is still relevant today. J Psychosom Res. 2009;67(6):607–11.

    Article  PubMed  Google Scholar 

  9. Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64(8):1155–61.

    Article  CAS  PubMed  Google Scholar 

  10. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45(5):637–51.

    Article  PubMed  Google Scholar 

  11. Titscher G, Schöppl C, Gaul G. Aufgaben und Möglichkeiten integrierter psychokardiologischer Versorgung. J Kardiol. 2010;17:36–42.

    Google Scholar 

  12. Titscher G. Psychosomatische Konsiliar-Liaison-Dienste in der Kardiologie. In: Hermann-Lingen Ch, Albus Ch, Titscher G, editors. Psychokardiologie. Köln: Deutscher Ärzte Verlag; 2014. pp. 249–60.

    Google Scholar 

  13. Schneider W, Basler H, Beisenherz B. Fragebogen zur Messung der Psychotherapiemotivation. Weinheim: Beltz; 1990.

    Google Scholar 

  14. Schneider W, Klauer T. Symptom level, treatment motivation, and the effects of inpatient psychotherapy. Psychother Res. 2001;11(2):153–67.

    Article  Google Scholar 

  15. Schneider W, Klauer T, Janssen P, Tetzlaff M. Zum Einfluß der Psychotherapiemotivation auf den Psychotherapieverlauf. Nervenarzt. 1999;70:240–9.

    Article  CAS  PubMed  Google Scholar 

  16. Nickel C, Tritt K, Kettler C, et al. Motivation for therapy and the results of inpatient treatment of patients with a generalized anxiety disorder: A prospective study. Wien Klin Wochenschr. 2005;117(9–10):359–63.

    Article  PubMed  Google Scholar 

  17. Miehsler W. Assessing the demand for psychological care in chronic diseases. Developement and validation of a questionnaire based on the example of inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(5):9–11.

    Article  Google Scholar 

  18. Miehsler W, Dejaco C, Moser G. Factor analysis of ADAPT questionnaire for assessment of subjective need for psychological interventions. Inflamm Bowel Dis. 2008;14(1):142–3.

    Article  PubMed  Google Scholar 

  19. Miehsler W, Weichselberger M, Offerlbauer-Ernst A, et al. Which patients with IBD need psychological interventions? A controlled study. Inflamm Bowel Dis. 2008;14(9):1273–80.

    Article  PubMed  Google Scholar 

  20. Bullinger M, Kirchberger I. SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. Göttingen: Hogrefe; 1998.

    Google Scholar 

  21. Ulvik B, Bjelland I, Hanestad BR, Omenaas E, Wentzel-Larsen T, Nygård O. Comparison of the short form 36 and the hospital anxiety and depression scale measuring emotional distress in patients admitted for elective coronary angiography. Heart Lung. 2008;37(4):286–95.

    Article  PubMed  Google Scholar 

  22. Ware J, Kosinski M, Keller S. SF-36 physical and mental health summary scales: a user’s manual. Boston: The Health Institute, New England Medical Center; 1994.

    Google Scholar 

  23. Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1997.

    Google Scholar 

  24. Ware J. The SF-36 Health Survey. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven Publishers; 1996. pp. 337–45.

    Google Scholar 

  25. Herrmann C. International experiences with the hospital anxiety and depression scale – a review of validation data and clinical results. J Psychosom Res. 1997;42(1):17–41.

    Article  CAS  PubMed  Google Scholar 

  26. De Smedt D, Clays E, Doyle F, et al. Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients. Int J Cardiol. 2013;167(5):2294–9.

    Article  PubMed  Google Scholar 

  27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  CAS  PubMed  Google Scholar 

  28. Rozanski A. Integrating psychologic approaches into the behavioral management of cardiac patients. Psychosom Med. 2005;67(Suppl 1):S67–73.

    Article  PubMed  Google Scholar 

  29. Ketterer MW, Knysz W, Keteyian SJ, et al. Cardiovascular symptoms in coronary-artery disease patients are strongly correlated with emotional distress. Psychosomatics. 2008;49(3):230–4.

    Article  PubMed  Google Scholar 

  30. Kubzansky LD, Davidson KW, Rozanski A. The clinical impact of negative psychological states: expanding the spectrum of risk for coronary artery disease. Psychosom Med. 2005;67(Suppl 1):S10–4.

    Article  PubMed  Google Scholar 

  31. Brody D, Khaliq A, Thompson T. Patients’ perspectives on the management of emotional distress in primary care settings. J Gen Intern Med. 1997;12(7):403–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Baum A, Garofalo J, Yali A. Socioeconomic status and chronic stress. Does stress account for SES effects on health? Ann N Y Acad Sci. 1999;896:131–44.

    Article  CAS  PubMed  Google Scholar 

  33. Jorm A, Windsor T, Dear K, Anstey K, Christensen H, Rodgers B. Age group differences in psychological distress: the role of psychosocial risk factors that vary with age. Psychol Med. 2005;35(9):1253–63.

    Article  CAS  PubMed  Google Scholar 

  34. Herrmann AS, Huber D. Was macht stationäre Psychotherapie erfolgreich? Der Einfluss von Patienten- und Behandlungsmerkmalen auf den Therapieerfolg in der stationären Psychotherapie. Z Psychosom Med Psychother. 2013;59:273–89.

    PubMed  Google Scholar 

  35. Angermeyer MC, Matschinger H. Public attitude towards psychiatric treatment. Acta Psychiatr Scand. 1996;94(5):326–36.

    Article  CAS  PubMed  Google Scholar 

  36. Ha JF, Anat DS, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38–43.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. II. Medical Department, Cardiology, Hanusch Krankenhaus, Vienna, Austria

    Evelyn Kunschitz, Christine Schöppl & Johann Sipötz

  2. Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria

    Evelyn Kunschitz, Oliver Friedrich & Johann Sipötz

  3. III. Medical Department, Cardiology, Wilhelminenspital, Vienna, Austria

    Thomas W. Weiss

  4. Medical Faculty, Sigmund Freud University, Vienna, Austria

    Thomas W. Weiss

  5. Department of Internal Medicine, Hospital of the Brothers of St. John of God, Salzburg, Austria

    Wolfgang Miehsler

  6. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria

    Gabriele Moser

Authors
  1. Evelyn Kunschitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Schöppl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas W. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolfgang Miehsler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johann Sipötz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gabriele Moser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evelyn Kunschitz.

Ethics declarations

Conflict of interest

E. Kunschitz, O. Friedrich, C. Schöppl, T. Weiss, W. Miehsler, J. Sipötz and G. Moser declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kunschitz, E., Friedrich, O., Schöppl, C. et al. Assessment of the need for psychosomatic care in patients with suspected cardiac disease. Wien Klin Wochenschr 129, 225–232 (2017). https://doi.org/10.1007/s00508-016-1050-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-016-1050-5

Keywords

Search

Navigation