مقایسۀ حساسیت اضطرابی و راهبردهای مقابله با استرس بین بیماران درد غیرقلبی قفسۀ سینه، بیماران قلبی و افراد سالم در شهر شیراز
محورهای موضوعی : تربیتی
1 - عضو هیأت دانشگاه آزاد اسلامی واحد فسا، شیراز، ایران
کلید واژه: حساسیت اضطرابی, درد غیر قلبی قفسۀ سینه, بیماران قلبی, راهبردهای مقابله,
چکیده مقاله :
هدف این پژوهش مقایسۀ حساسیت اضطرابی و راهبردهای مقابله با استرس بین بیماران درد غیرقلبی قفسۀ سینه، بیماران قلبی و افراد سالم است. طرح پژوهش از نوع علّی ـ مقایسهای، جامعۀ آماری همۀ بیماران درد قفسۀ سینه مراجعهکننده به مراکز پزشکی شهر شیراز در سال 1392 بودند. آزمودنیها 50 بیمار قلبی عروقی (28زن و 22 مرد)، 50 بیمار درد غیرقلبی قفسۀ سینه (29 زن و 21مرد) و 50 نفر (27 زن و 23 مرد) از افراد سالم در محدودۀ سنی22 تا 81 سال بودند که به شیوۀ نمونهگیری هدفمند انتخاب شدند. ابزارهای پژوهش عبارت بودند از فهرست تجدیدنظر شدۀ حساسیت اضطرابی (تیلور و کاکس، 1998)، پرسشنامۀ مقابله با موقعیتهای تنشزا (پارکر و اندلر، 1990) و فهرست محققساختۀ اطلاعات جمعیتشناختی. دادهها با استفاده از نرمافزار SPSS و بهرهگیری از آزمون آماری تحلیل واریانس یکطرفه و مجذور کای مورد تجزیه و تحلیل قرار گرفتند. یافتهها نشان داد که هم بیماران قلبی و هم بیماران درد غیر قلبی قفسۀ سینه بهطور معناداری کمتر از افراد سالم از راهبردهای مقابلهای حل مسأله (01/0P<) و بیشتر از افراد سالم از راهبردهای مقابلهای هیجانمدار (01/0P<) و اجتنابی (05/0P<) استفاده کردهاند. همچنین در نشانههای ششگانه و نمرۀ کل حساسیت اضطرابی گروه بیماران درد غیرقلبی قفسۀ سینه دارای بیشترین حساسیت به همۀ نشانهها و گروه سالم از این نظر دارای کمترین حساسیت بود، و بیماران قلبی بین این دو گروه قرار میگرفتند و تفاوت هر دو گروه بیمار با گروه سالم معنادار بود (05/0P<). در نتیجه متغیرهای روانشناختی نظیر حساسیت اضطرابی و شیوههای مقابله با استرس از توان بالایی در پیشبینی فراوانی و شدت درد بهویژه در بیماران درد غیرقلبی قفسۀ سینه برخوردار است.
The main propose of this study was to compare the anxiety sensitivity and coping stress strategies between patients with non-cardiac chest pain, cardiac disease and healthy individuals. An ex-post- facto design was used as the research design. The population included all patients with non-cardiac and cardiac chest pain who referred to Shiraz health centers in 2013. Subjects were 50 cardiac patients (28 females and 22 males), 50 patients with non-cardiac chest Pain (29 females and 21 males) and 50 people as normal matched group (27 female and 23 male) within 22 to 81 years old age range who were selected through purposive sampling method. The instruments for data collection consisted of Anxiety Sensitivity Index (Taylor & Cox, 1998), Coping Inventory for Stressful Situations (Parker & Endler, 1990), and a researcher-made demographic information checklist. Then the data was analyzed with one way analysis of variance and chi square. Results indicated that both cardiac and non- cardiac chest pain patients significantly are lower than normal matched group in using problem solving coping strategies (P<0.01) and higher in using emotional (P<0.01) and avoidance coping strategies (P<0.05). Results also indicated that non-cardiac chest pain patients showed highest sensitivity to all 6 subscales and normal group showed lowest sensitivity. In this regard, patients with cardiac disease could stand between the two groups and both groups of patients were significantly different from the normal healthy group (P<0.05). As a conclusion, psychological variables such as anxiety sensitivity and coping stress strategies can predict pain frequency, severity and treatment seeking especially for patients with Non –cardiac chest pain.
Asbury, E., Collins, P. (2005). Psychosocial factors associated with non-cardiac chest pain and X cardiac syndrome. Herz 30(1), 55–60.
Bernstein, A., Zvolensky, M.J., Kotov, R., Arrindell, W.A., Taylor, S., Sandin, B., Cox, B.J., Stewart, S.H., & Bouvard M. (2006). Taxonicity of anxiety sensitivity: a multi-national analysis. Anxiety Disorders, 20, 1–22.
Cheng, C., Wong , W.M., Lai, K.C., Wong, B.C., Hu, W.E., Hui, W.M., Lam S.K. (2003). Psychosocial factors in patients with non-cardiac chest pain. Psychosomatic Medicine, 65, 443–449
Cheung, TK., Hou, X., Lam, KF., Chen, J., Wong, WM., Cha, H., Xia, HH., Chan, AO., Tong, TS., Leung, Gy., Yuen, MF., Wong, BC. (2009). Quality of life and psychological impact on patients with non-cardiac chest Pain. Clinical Gastroenterology, 43 (1), 13-18.
Cintron, J.A., Carter, M.M., Suchday, S., Sbrocco, T., Gray J. (2005). Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans. Anxiety Disorders 19, 51–68.
Cox, B.J., Borger, S.C., Taylor, S., Fuentes, K., & Ross, L.M. (1999). Anxiety sensitivity and the five factor model of personality. Behavior Research and Therapy, 37(7), 633-641.
Flett, G.L., Greene, A. Hewitt P.L. (2004). Dimensions of perfectionism and anxiety sensitivity. Rational-Emotive & Cognitive-Behavior Therapy, 22(1), 39-57.
García-Campayo, J., Rosel, F., Serrano, P., Santed, M.A., Andrés, E., Roca, M., Blanco, A.S., and Latre, M.L. (2010). Different psychological profiles in non-cardiac chest pain. Rev ESP Cardiol, 63(3), 357-61.
Gilleland, J., Blount, R.L., Campbell R.M., Johnson, G.L., Dooley, K.J., and Simpson, P. (2009). Psychosocial factors and pediatric non-cardiac chest pain. Pediatric Psychology, 34(10), 1170–1174.
Ho, K.Y., Kang, J.Y., Yeo, B., & Ng, W.L. (1998). Non-cardiac, non- esophageal chest pain: the relevance of psychological factors. Gut, 43, 105–110.
Kachintorn, U. (2005). How do we define non-cardiac chest pain? Gastroenterology and Hepatology, 20, 2–5.
Kisely, S.R., Campbell, L.A., Yelland, M.J. Paydar, A. (2012). Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. (Review), Issue 6 Published by John Wiley & Sons, Ltd. available at: http://www.thecochranelibrary.com.
Krantz, D.S., Mc Ceney, M.K. (2002). Effects of psychological and social factors on organic disease: A critical assessment of research on coronary heart disease. Annu Rev Psycho, 53, 341–369.
Lipsitz J.D., Warner, C., Apfel, H. Marans, Z., Hellstern, B., Forand, N., Levenbraun, Y., and Fyer, A.J. (2004). Anxiety and depressive symptoms and anxiety sensitivity in youngsters with non-cardiac chest pain and benign heart murmurs. Pediatric Psychology, 28(8), 607–612.
Loiselle, K.A., Lee, J.L., Gilleland, J., Campbell, R., Simpson, P., Johnson, G., Dooley, K., and Blount, R.L. (2012). Factors associated with healthcare utilization among children with non-cardiac chest pain and innocent heart murmurs. Pediatric Psychology, 1, 1–9.
Mantanr, A., Yemez, B., Alkin, T. (2010). The validity and reliability of the Turkish version of the Anxiety Sensitivity Index-3. Turkish J of Psychiatry (Türk Psikiyatri Dergisi), 1, 1-9.
Nezu, A.M., Nezu, C.M., Jain, D., Xanthopoulos, M.SH., Cos, T.A., Friedman, J., & Lee, M. (2007). Social problem solving and non-cardiac chest pain. Psychosomatic Medicine, 69, 944–951.
Rodriguez, B.F., Bruce, S.E., Pagano, M.E., Spencer, M.A., Keller M.B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy, 42(1), 79-91.
Sheehan, A. (2012). Non-cardiac chest pain: the role of physical, psychosocial, and service-related factors in the persistence of pain and health service use. PhD theses Royal College of Surgeons in Ireland. Available at http://epubs.rcsi.ie/phdtheses
Shekhar, C., Whorwell, P.J. (2008). Evaluation and management of patients with non-cardiac chest pain. Gastroenterology Research and Practice. 1, 1-4.
Shelby, R.A., Somers, T.J., Keefe, F.J., Silva, S.G., Mckee, D.C., She, L., Waters, S.J., Varia, I., Riordan, Y.B., Knowles, V.M., Blazing, M., Blumenthal, J.A. & Johnson, P. (2009). Pain catastrophizing in patients with non-cardiac chest pain: Relationships with pain, anxiety، and disability. Psychosomatic Medicine, 71, 861–868.
Stein, D.S. (2007) Psychological and sociodemographic factors in the non-cardiac chest pain population impacting performance on the Cardiac Stress Test. July 23, 2007, Submitted in Partial Fulfillment of the Requirements of the Degree of Doctor of Psychology. Massachusetts School of Professional Psychology.
White, K.S., McDonnell, C.J., Gervino, E.V. (2011). Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. J. Behav. Ther & Exp. Psychiat. 42(2001) 432-439.
Wong, W.M., Lam, K.F., Cheng, C., Hui, W.M., Xia, H.H., Lai, K.C., Hu, W.H., Huang, J.Q., Lam, C.L., Chan, C.K., Chan, A.O., Lam, S.K., Wong, B.C. (2004). Population based study of non-cardiac chest pain in southern Chinese: Prevalence, psychosocial factors and health care utilization. World J of Gastroenterology. 10(5), 707-71.