Illness Representation After Acute Myocardial Infarction: Impact on In-Hospital Recovery

Candace C. Cherrington, PhD, RN, Miami Valley College of Nursing & Health, Wright State Univeristy, Dayton, OH, USA, Debra K. Moser, DNSc, RN, College of Nursing, University of Kentucky, Lexington, KY, USA, Terry A. Lennie, PhD, RN, College of Nursing, Univeristy of Kentucky, Lexington, KY, USA, and Carol W. Kennedy, PhD, RN, College of Nursing, The Ohio State University, Columbus, OH, USA.

Sample, Setting, Years: Subjects (n = 49, age 61±13 years; 49% male) had confirmed MI. Data were collected in a CCU of a Midwestern academic medical center from 2-12, 2000.

Concepts and Variables Studied: Illness representation, depression, anxiety, heart rate variability (HRV), salivary cortisol and complications

Method: All data were within 24-48 hours of admission. Data on illness representation, depression and anxiety were collected using the Illness Perception Questionnaire, Beck Depression Inventory, and Spielberger State Anxiety Index respectively. Beat-to-beat heart rate data were collected from a 1 hour Holter recording and assessed for time and frequency domain measures of HRV. Salivary cortisol was assessed by immunoassay. Complications were assessed by chart review. Hierarchical multiple regression was used to analyze data.

Findings: There was a relationship between illness representation and depression (adjusted R2=.409, p=.001) and anxiety (adjusted R2=.42, p=.001) while controlling for sociodemographics, health history and ejection fraction. Holding all independent variables constant, for each one unit increase in illness representation score the odds of having a complication increased 8.3% (p=.018). Illness representation was not related to HRV or salivary cortisol.

Conclusions: Persons with a negative representation of having suffered MI are more likely to be depressed or anxious and to experience a complication during hospitalization.

Implications: This study reinforces the need for nurses to be aware of the meaning and significance of illness to persons recovering from MI.

Learning Objective #1: Describe the relationship among illness representation and complications of MI
Learning Objective #2: Describe the interaction between illness representation, depression, and anxiety and the impact on recovery