Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event

Abstract

Objective: The purpose of this study was to test the effect of a post-discharge telephone counseling intervention on women's psychosocial adjustment following a cardiac event.

Design: The study was a prospective, randomized, controlled trial.

Patients: Women (n = 196) were recruited from 4 hospitals in Sydney, Australia, who were hospitalized for coronary artery disease: myocardial infarction, coronary artery bypass grafts, coronary angioplasty, or stable angina. Women were randomized to usual care (n = 103) or telephone counseling (n = 93) and were 67 years of age (range 34-92). The majority had not completed high school (92%) and were not employed (84%).

Outcomes: Psychosocial adjustment was measured by the Psychosocial Adjustment to Illness Scale and the Hospital Anxiety and Depression Scale the day before hospital discharge and 12 weeks postdischarge.

Intervention: Individualized information and support, was designed to promote self-managed recovery and psychosocial adjustment, and began with an evaluation during admission and was followed up by telephone counseling at 1, 2, 3, and 6 weeks after discharge.

Results: The intervention had no effect on psychosocial adjustment (F[1,182] = 0.06, P =.8), anxiety (F[1,182] = 0.15, P =.69) or depression (F[1,182] = 0.11, P =.74) at 12 weeks after discharge. Women made significant improvements during the 12 weeks on mean scores for psychosocial adjustment (F[1,182] = 58.37, P =.00), anxiety (F [1,182] = 74.58, P =.00) and depression (F[1,182] = 14.11, P =.00). The predictors of poor psychosocial outcomes for women included being less than 55 years of age, being unemployed or retired, having poor psychosocial adjustment to illness at baseline, having readmission, or experiencing a stressful, personal event during follow-up.

Conclusions: Women at risk for poor outcomes following hospitalization for a cardiac event can be identified (ie, women less than 55 years of age, unemployed or retired, poorly adjusted to their cardiac illness, or readmitted to hospital within 12 weeks of a previous cardiac admission), but an effective intervention to enhance psychosocial outcomes remains to be established.