Factors associated with changes in psychological distress in patients participating in a nursing intervention program after a myocardial infarction
Bibliographic record
Abstract
Many patients experience psychological distress following a myocardial infarction (MI). Emotional problems can interfere with a return to family, social and work-related activities, and are associated with poor cardiac prognosis. Although many psychosocial intervention programs designed for this population have been evaluated, little is known about which components of the interventions are effective. The major aim of the present secondary analysis was to identify the types of patient-nurse interactions associated with a reduction in psychological distress in post-MI patients who participated in the Montreal Heart Attack Readjustment Trial (M-HART) randomized controlled study of home-based psychosocial nursing interventions. The sample for the present study included 431 patients (36.2% female) in the treatment group who received at least two home nursing visits over a two-month period. The types of concerns experienced by patients (those related to symptoms, treatment, uncertainty, interpersonal roles, and work/finance) and the types of nursing approaches undertaken during the first two home visits (cognitive, educational, emotionally supportive including reassurance/encouragement, listening and providing advice, and managerial) were examined in relationship to short-term changes in distress. These relationships were examined in the sample as a whole and also in subgroup analyses where gender and baseline level of depressive symptoms were taken into account. In the sample as a whole, reassurance/encouragement and listening were related to a reduction in distress, but mainly for patients who had physical symptoms and treatment-related concerns. The provision of advice for psychologically-related concerns such as fears was not associated with better outcomes. However, nursing approaches that were more directive (educational, cognitive and advice) appeared to have been linked to better outcomes in men, but less so in women, while listening was associated with reductions in distress in women, but not in men. Reductions in distress after the two visits was less common in patients with higher baseline levels of depressive symptoms, and those who presented psychologically-related concerns. Finally, patients who showed short-term reductions in distress had lower death rates, lower readmission rates, and a lower risk of reporting depressive symptoms at one year. These results highlight the importance of determining the types of intervention approaches that may be most effective in men and in women, and identifying patients who are more and less likely to benefit from psychosocial interventions such as those provided in M-HART. It is also particularly notable that post-MI patients whose short-term psychological distress is reduced by individualized psychosocial interventions appear to have improved cardiac prognosis and reduced depressive symptoms in the longer term.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".