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Journal of Behavioral Medicine

, Volume 22, Issue 2, pp 157–177 | Cite as

Psychosocial Adjustment and Mental Health Two Months After Coronary Artery Bypass Surgery: A Multisystemic Analysis of Patients' Resources

  • Yoel Elizur
  • Eli Hirsh
Article

Abstract

Resources related to cardiac patients' sense of self, marital quality, and social support were assessed before their first planned bypass surgery to determine their relationship with later psychosocial functioning. Six female and 45 male cardiac patients, 45-70 years old, answered self-report instruments 1 week before and 8-10 weeks after the operation. Regression analyses indicated that only the marital relationship variables made independent contributions to the prediction of functioning. Since self-report measures of resources can be affected by negative affectivity, a second level of analysis predicted change scores while controlling for initial levels of functioning. Marital flexibility and support were found to make an independent contribution to recovery. These results highlight the importance of marital resources in coping with the acute phase following bypass surgery and have implications for prevention and clinical practice.

BYPASS SURGERY CARDIAC ILLNESS SOCIAL SUPPORT MARITAL SUPPORT ADAPTABILITY SELF-EFFICACY 

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REFERENCES

  1. Allen, J. K., Becker, D. M., and Swank, R. T. (1990). Factors related to functional status after coronary artery bypass surgery. Heart Lung 19: 337-343.Google Scholar
  2. Antonovsky, A. (1987). Unraveling the Mystery of Health: How People Manage Stress and Stay Well, Jossey-Bass, San Francisco.Google Scholar
  3. Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory, Prentice Hall, Englewood Cliffs, NJ.Google Scholar
  4. Bandura, A. (1991). Human agency: The rhetoric and the reality. Am. Psychol. 46: 157-162.Google Scholar
  5. Beach, S. R. H., Martin, J. K., Blum, T. C., and Roman, P. M. (1993). Effects of marital and coworker relationships on negative affect: Testing the central role of marriage. Am. J. Family Ther. 21: 312-322.Google Scholar
  6. Berkman, F. L. (1985). The relationship of social networks and social support to morbidity and mortality. In Cohen, S., and Syme, S. L. (eds.). Social Support & Health, Academic Press, New York.Google Scholar
  7. Broadhed, W. E., Kaplan, B. H., and James, S. A. (1983). The epidemiological evidence for relationship between social support and health. Am. J. Epidemiol. 117: 521-537.Google Scholar
  8. Burke, R. J., and Weir, T. (1977). Marital helping relationships: The moderators between stress and well being. J. Psychol. 85: 121-130.Google Scholar
  9. Burke, M. J., Brief, A. P., and George, J. M. (1993). The role of negative affectivity in understanding relations between self-reports of stressors and strains: A comment on the applied psychology literature. J. Appl. Psychol. 78: 402-412.Google Scholar
  10. Burker, E. J., Blumenthal, J. A., Feldman, M., and Burnett, R., et al. (1995). Depression in male and female patients undergoing cardiac surgery. Br. J. Clin. Psychol. 34: 119-128.Google Scholar
  11. Burman, B., and Margolin, G. (1992). Analysis of the assocaitation between marital relationships and health problems: An interactional perspective. Psychol. Bull. 112: 39-63.Google Scholar
  12. Campbell, T. L., and Patterson, J. M. (1995). The effectiveness of family interventions in the treatment of physical illness. J. Marital Family Ther. 21: 545-583.Google Scholar
  13. Cassileth, R. B., Lusk, E. J., Strouse, T. B., Miller, D. S., Brown, L. L., Cross, P. A., and Tengalia, A. N. (1984). Psychosocial status in chronic illness: A comparative analysis of six diagnostic groups. N. Engl. J. Med. 311: 506-511.Google Scholar
  14. Christian, J. L., O'Leary, K. D., and Vivian, D. (1994). Depressive symptomatology in maritally discordant women and men: The role of individual and relationship variables. J. Family Psychol. 8: 32-42.Google Scholar
  15. Cobb, S. (1982). Social support and health throughout the life course. In McCubbin, H. I., Cauble, A. E., and Patterson, J. M. (eds.). Family Stress, Coping, and Social Support, Charles C Thomas, Springfield, IL, pp. 189-199.Google Scholar
  16. Coyne, J. C., and Delongis, A. (1986). Going beyond social support. J. Consult. Clin. Psychol. 54: 454-460.Google Scholar
  17. Coyne, J. C., and Smith, D. A. F. (1991). Couples coping with a myocardial infarction: A contextual perspective on wives' distress. J. Person. Soc. Psychol. 61: 404-412.Google Scholar
  18. Coyne, J. C., and Smith, D. A. F. (1994). Couples coping with a myocardial infarction: Contextual perspective on patient self-efficacy. J. Family Psychol. 8: 43-54.Google Scholar
  19. Cumsille, P. E., and Epstein, N. (1994). Family cohesion, family adaptability, social support, and adolescent depressive symptoms in outpatient clinic families. J. Family Psychol. 8: 202-214.Google Scholar
  20. Derogatis, L. R., and Lopez, M. C. (1983). Psychosocial Adjustment to Illness Scale (PAIS & PAISSR) Scoring, Procedure, and Administration Manual—I, Clinical Psychometric Research, Baltimore.Google Scholar
  21. Devins, G. M., Binik, I. M., Gorman, M., Dattel, M., McCloskey, B., Oscar, G., and Briggs, J. (1982). Perceived self-efficacy, outcome expectation and negative mood states in end stage of renal disease. J. Abnorm. Psychol. 91: 241-244.Google Scholar
  22. Drory, Y. (1993). Rehabilitation of the Cardiac Patient, Universities Press, Tel Aviv (Hebrew).Google Scholar
  23. Drory, Y., and Florian, V. (1991). Long-term psychosocial adjustment to coronary artery disease. Arch. Phys. Med. Rehab. 72: 326-331.Google Scholar
  24. Dundas, I. (1994). The family adaptability and cohesion scale III in a Norwegian sample. Family Process 33: 191-202.Google Scholar
  25. Elizur, Y. (1994). Whose pain is it Consulting at the interface between families and social-medical systems. In Andolfi, M., and Haber, R. (eds.), Please Help Me with This Family: Using Consultants as Resources in Family Therapy, Brunner/Mazel, New York, pp. 162-180.Google Scholar
  26. Elizur, Y. (1995). Ecosystemic consultation in the kibbutz: Social process and narrative in two cases of community “epidemic.” Contemp. Family Ther. 17: 483-501.Google Scholar
  27. Elizur, Y. (1996). Involvement, collaboration, and empowerment: A model for consultation with human-service agencies and the development of family-oriented care. Family Process 35: 191-210.Google Scholar
  28. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science 196: 129-136.Google Scholar
  29. Ewart, C. K., Taylor, C. B., Reese, L. B., and DeBusk, R. F. (1983). The effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity. Am. J. Cardiol. 51: 1076-1080.Google Scholar
  30. Fielding, R. (1991). Depression and acute myocardial infarction: A review and reinterpretation. Soc. Sci. Med. 32: 1017-1027.Google Scholar
  31. Fincham, F. D., Beach, S. R., and Bradbury, T. N. (1989). Marital distress, depression and attributions: Is the marital distress-attribution association an artifact of depression? J. Consult. Clin. Psychol. 57: 768-771.Google Scholar
  32. Fitzgerald, S. T., Becker, D. M., Celentano, D. D., Swank, R., and Brinker, R. (1989). Return to work after percutaneous transluminal coronary angioplasty. Am. J. Cardiol. 64: 1108-1112.Google Scholar
  33. Florian, V., and Drory, Y. (1990). Mental Health Inventory (MHI): Psychometric properties and normative data in the Israeli population. Psychologia Israel J. Psychol. 2(1): 26-35 (Hebrew).Google Scholar
  34. Fontana, A. F., and Kerns, R. D. (1989). Support, stress, and recovery from coronary heart disease. Health Psychol. 8: 175-193.Google Scholar
  35. Gortner, S. R., and Jenkins, L. S. (1990). Self-efficacy and activity level following cardiac surgery. J. Adv. Nurs. 15: 1132-1138.Google Scholar
  36. Gottman, J. M. (1989). Toward programmatic research in family psychology. J. Family Psychol. 3: 211-214.Google Scholar
  37. Gottman, J. M., and Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. J. Person. Soc. Psychol. 63: 221-233.Google Scholar
  38. Green, R. G., Harris, R. N., Forte, J. A., and Robinson, M. (1991). Evaluating FACES III and the circumplex model: 2,440 families. Family Process 30: 55-73.Google Scholar
  39. Gundle, M. J., Reeves, B. R., and Tate, S. (1980). Psychosocial outcome after coronary artery surgery. Am. J. Psychiatry 137: 1591-1594.Google Scholar
  40. Hanson, C. L., and Harris, M. A. (1989). Coping styles in youths with insulin-dependent diabetes mellitus. J. Consult. Clin. Psychol. 57: 644-651.Google Scholar
  41. Hauser, R. T., Jacobson, A. M., and Lavori, P. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus. J. Pediatr. Psychol. 15: 527-542.Google Scholar
  42. Hawley, D. R., and DeHaan, L. (1996). Toward a definition of family resilience: Integrating life-span and family perspectives. Family Process 35: 283-298.Google Scholar
  43. Hewitt, P. L., Flett, G. L., and Mikail, S. F. (1995). Perfectionism and relationship adjustment in pain patients and their spouses. J. Family Psychol. 9: 335-347.Google Scholar
  44. Heyman, R. E., Sayers, S. L., and Bellak, A. S. (1994). Global marital satisfaction versus marital adjustment: An empirical comparison of three measures. J. Family Psychol. 8: 432-446.Google Scholar
  45. Hobfoll, S. E., London, P., and Orr, E. (1988). Mastery, intimacy, and stress resistance during war. J. Commun. Psychol. 16: 317-331.Google Scholar
  46. Hobfoll, S. E., Dunahoo, C. A., and Monnier, J. (1995). Conservation of resources and traumatic stress. In Freedy, J. R., and Hobfoll, S. E. (eds.). Traumatic Stress: From Theory to Practice, Plenum Press, New York, pp. 29-47.Google Scholar
  47. Hock, E., Schirtzinger, M. B., and Lutz, W. (1992). Dimensions of family relationships associated with depressive symptomatology in mothers of young children. Psychol. Women Q. 16: 229-241.Google Scholar
  48. Holahan, C. K., and Holahan, C. J. (1987). Self-efficacy, social support, and depression in aging: A longitudinal analysis. J. Gerontol. 42: 65-68.Google Scholar
  49. Holahan, C. J., Moos, R. H., Holahan, C. K., and Brennan, P. L. (1995). Social support, coping, and depressive symptoms in a late middle-aged sample of patients reporting cardiac illness. Health Psychol. 14: 152-163.Google Scholar
  50. Holahan, C. J., Holahan, C. K., Moos, R. H., and Brennan, P. L. (1997). Social context, coping strategies, and depressive symptoms: An expanded model with cardiac patients. J. Personal. Soc. Psychol. 72: 918-928.Google Scholar
  51. Imber-Black, E. (1988). Families and Larger Systems, Guilford Press, New York.Google Scholar
  52. James, S.D., and Johnson, D. W. (1988). Social interdependence, psychological adjustment, and marital satisfaction in second marriages. J. Soc. Psychol. 128: 287-303.Google Scholar
  53. Jensen, K., Banwart, L., Venhaus, R., Popkess-Vawter, S., and Perkins, S. B. (1993). Advanced rehabilitation nursing care of coronary angioplasty patients using self-efficacy theory. J. Adv. Nurs. 18: 926-931.Google Scholar
  54. Kaplan De-Nour, A. (1982). Psychosocial adjustment to illness scale (PAIS): A study of chronic hemodialysis patients. J. Psychosom. Res. 26: 11-22.Google Scholar
  55. Katz, S. (1985). The Relationships Between Social Support, Mother's Coping Behaviors and Perception of Her Chronically Ill Child with a Congenital Heart Disease, Unpublished master's thesis, Bar Ilan University, Ramat Gan, Israel.Google Scholar
  56. Kazak, A., and Meadows, A. (1989). Families of young adolescents who have survived cancer: Socio-emotional adjustment, adaptability and social support. J. Pediatr. Psychol. 14: 175-191.Google Scholar
  57. Kenny, D. A., and Zautra, A. (1995). The trait-state-err or model for multiwave data. J. Consult. Clin. Psychol. 63: 52-59.Google Scholar
  58. King, K. B., Reis, H. T., Porter, L. A., and Norsen, L. H. (1993). Social support and long term recovery from coronary artery surgery: Effects on patients and spouses. Health Psychol. 12: 56-63.Google Scholar
  59. Kobasa, S. C., Madi, S. R., and Kahn, S. (1982). Hardiness and health: A prospective study. J. Person. Soc. Psychol. 42: 168-177.Google Scholar
  60. Krahn, G. L. (1993). Conceptualizing social support in families of children with special health needs. Family Process 32: 235-248.Google Scholar
  61. Kriegsman, D. M. W., Penninx, B. W. J. H., and van Eijk, J. T. M. (1995). A criterion-based literature survey of the relationship between family support and incidence and course of chronic disease in the elderly. Family Syst. Med. 13: 39-68.Google Scholar
  62. Kulic, J. A., and Mahler, H. I. M. (1989). Social support and recovery from surgery. Health Psychol. 8: 221-238.Google Scholar
  63. Kurdeck, L. A., and Sinclair, R. J. (1988). Adjustment of young adolescents in two-parent nuclear, step-father, and mother-custody families. J. Consult. Clin. Psychol. 56: 91-96.Google Scholar
  64. Ladwig, K. H., Roll, G., Breithardt, G., Buddle, T., and Borggrefe, M. (1994). Post-infar ction depression and incomplete recovery 6 months after actue myocardial infarction. Lancet 343: 20-23.Google Scholar
  65. Lazarus, R. S., and Folkman, S. (1984). Stress, Appraisal, and Coping, Springer, New York.Google Scholar
  66. Levenson, R. W., Carstensen, L. L., and Gottman, J. M. (1993). Long-term marriage: age, gender, and satisfaction. Psychol. Aging 8: 301-313.Google Scholar
  67. Linden, W., Stossel, C., and Maurice, J. (1996). Psychosocial interventions for patients with coronary artery disease: A meta-analysis. Arch. Intern. Med. 156: 745-752.Google Scholar
  68. Manne, S. L., Taylor, K. L., Dougherty, J., and Kemeny, N. (1997). Supportive and negative responses in the partner relationship: Their association with psychological adjustment among individuals with cancer. J. Behav. Med. 20: 101-125.Google Scholar
  69. McCubbin, M. A., and McCubbin, H. I. (1989). Theoretical orientations to family stress and coping. In Figley, C. R. (ed.), Treating Stress in Families, Brunner/Mazel, New York, pp. 3-43.Google Scholar
  70. Minkler, M. (1985). Social support and the health of the elderly. In Cohen, S., and Syme, S. L. (eds.), Social Support & Health, Academic Press, New York.Google Scholar
  71. Morrow, G. R., Chiarello, R. J., and Derogatis, L. R. (1978). A new sale for assessing patient's psychosocial adjustment to medical Illness. Psychol. Med. 8: 605-610.Google Scholar
  72. Neuling, S., and Winefield, H. (1988). Social support and recovery after surgery for breast cancer: Frequency and correlates of supportive behaviors by family, friends and surgeon. Soc. Sci. Med. 27: 385-392.Google Scholar
  73. Norbeck, J. S., Lindsey, A. M., and Carriery, V. L. (1981). The development of an instrument to measure social support. Nurs. Res. 30: 264-269.Google Scholar
  74. Norbeck, J. S., Lindsey, A. M., and Carriery, V. L. (1983). Further development of the Norbeck social support questionnaire. Nurs. Res. 32: 4-9.Google Scholar
  75. O'Leary, A. (1985). Self-efficacy and health. Behav. Res. Ther. 23: 437-451.Google Scholar
  76. Olson, D. H. (1989). Circumplex model and family health. In Ramsey, C. N., Jr. (ed.), Family Systems in Medicine, Guilford, New York, pp. 75-94.Google Scholar
  77. Olson, D. H. (1993). Circumplex model of marital and family systems: Assessing family functioning. In Walsh, F. (ed.), Normal Family Processes, Guilford, New York, pp. 104-137.Google Scholar
  78. Olson, D. H. (1994). Commentary: Curvilinearity survives: The world is not flat. Family Process 33: 471-478.Google Scholar
  79. Olson, D. H., Sprenkle, D. H., and Russel, C. S. (1979). Circumplex model of marital and family systems I: Cohesion and adaptability dimensions, family types, and clinical applications. Family Process 18: 3-28.Google Scholar
  80. Olson, D. H., Portner, J., and Lavee, Y. (1985). FACES III, Family Social Science, University of Minnesota, St. Paul.Google Scholar
  81. Pasch, L. A., and Bradbury, T. N. (1998). Social support, conflict, and the development of marital dysfunction. J. Consult. Clin. Psychol. 66: 219-230.Google Scholar
  82. Penninx, B. W. J. H., Kriegsman, D. M. W., van Eijk, J. T. M., Boeke, A. J. P., and Deeg, D. J. H. (1996). Differential effect of social support on the course of chronic disease: A criteria-based literature study. Families Syst. Health 14: 223-244.Google Scholar
  83. Pistrang, N., and Barker, C. (1995). The partner relationship in psychological response to breast cancer. Soc. Sci. Med. 40: 789-797.Google Scholar
  84. Procidano, E. P., and Heller, K. (1983). Measures of perceived social support from friends and from family: Three validation studies. Am. J. Commun. Psychol. 11: 1-24.Google Scholar
  85. Rait, D. S., Ostroff, J. S., Smilth, K., Cella, D. F., Tan, C., and Lesko, L. M. (1992). Lives in a balance: Perceived family functioning and the psychosocial adjustment of adolescence cancer survivors. Family Process 31: 383-397.Google Scholar
  86. Rogosa, D. R. (1988). Myths about longitudinal research. In Schaie, K. W., Campbell, R. T., Merideth, W., and Rawlings, S. C. (eds.), Methodological Issues in Aging Research, Springer, New York.Google Scholar
  87. Rolland, J. S. (1994). Families, Illness, and Disability: An Integrative Treatment Model, New York.Google Scholar
  88. Rutter, M. (1987). Psychological resilience and protective mechanisms. Am. J. Orthopsychiatry 57: 316-331.Google Scholar
  89. Schulz, R., and Tompins, C. A. (1990). Life events and changes in social relationships: Examples, mechanisms, and measurement. J. Soc. Clin. Psychol. 9: 69-77.Google Scholar
  90. Schumn, W. R., Nichols, C. W., Schectman, K. L., and Grigsby, C. C. (1983). Characteristics of responses to Kansas marital satisfaction scale by a sample of 84 married mothers. Psychol. Rep. 53: 567-572.Google Scholar
  91. Schumn, W. R., Anderson, S. A., Benigas, J. E., McCutchen, M. B., Griffin, C. L., Morris, J. E., and Race, G. S. (1985). Criterion-rela ted validity of the Kansas marital satisfaction scale. Psychol. Rep. 56: 719-722.Google Scholar
  92. Schumn, W. R., Paff-Bergen, L. A., Hatch, R. C., Obiorah, F. C., Copeland, J. M., Meens, L. D., and Bugaighis, M. A. (1986). Concurrent and discriminant validity of the Kansas marital satisfaction scale. J. Marriage Family 48: 381-387.Google Scholar
  93. Speer, D. C. (1994). Can treatment research inform decision makers? Nonexperimental method issues and examples among older outpatients. J. Consult. Clin. Psychol. 62: 560-568.Google Scholar
  94. Solomon, Z. (1993). Combat Stress Reaction, Plenum, New York.Google Scholar
  95. Teichman, Y., and Navon, S. (1990). Family evaluation—The circumplex model: Translation and adaptation to Hebrew of the third edition. Psychologia Israel J. Psychol. 2: 36-46 (Hebrew).Google Scholar
  96. Trelawny-Ross, C., and Russell, O. (1987). Social and psychological responses to myocardial infarction: Multiple determinants of outcome at six months. J. Psychosom. Res. 31: 125-130.Google Scholar
  97. Uchino, B. N., Cacioppo, J. T., and Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implication for health. Psychol. Bull. 119: 488-531.Google Scholar
  98. Veit, C. T., and Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. J. Consult. Clin. Psychol. 51: 730-742.Google Scholar
  99. Walsh, F. (1996). The concept of family resilience: Crisis and challenge. Family Process 35: 261-281.Google Scholar
  100. Waltz, M., and Badura, B. (1988). Subjective health, intimacy and perceived self-efficacy after heart attack. Soc. Indicators Res. 20: 303-332.Google Scholar
  101. Williams, P., William, A. W., Sommer, R., and Sommer, B. (1986). Survey of the California alliance for the mentally ill. Hosp. Commun. Psychiatry 37: 253-256.Google Scholar
  102. Wynne, L. C., McDaniel, S. H., and Weber, T. T. (Eds.). (1986). Systems Consultation: A New Perspective for Family Therapy, Guilford, New York.Google Scholar

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© Plenum Publishing Corporation 1999

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  • Yoel Elizur
  • Eli Hirsh

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