Exploring uncertainty and psychosocial adjustment after cardioverter defibrillator implantation

Abstract

Background: Sudden cardiac death is a leading cause of death in the Americas and Europe. Although the implantable cardioverter defibrillator (ICD) has decreased mortality from sudden cardiac death, it may be associated with psychosocial adjustment (PSA) problems and be a source of uncertainty for some recipients. The purpose of this study was to explore uncertainty and PSA among first-time ICD recipients during the first 2 months after hospital discharge.

Methods: Ninety-four adult, first-time ICD recipients recruited from 4 New England hospitals were studied at 1 week (S1) and 8 weeks (S2) after hospital discharge using a repeated-measures, correlational survey design. Mishel Uncertainty in Illness Scale, Psychosocial Adjustment to Illness Scale, and a demographic questionnaire were administered. Data were analyzed using descriptive and inferential statistics, including Pearson correlations, repeated-measures analysis of variance, multivariate canonical analysis, multiple regression, hierarchical regression, and 1-way analysis of variance.

Results: There was no change in the nature or level of uncertainty over time. Uncertainty at S1 explained a significant amount (39%) of the variance in overall PSA at S2. Psychosocial adjustment domains at S1 explained a large proportion (62%) of the variance in overall PSA at S2. Education, employment status, and functional status were related to uncertainty. Younger recipients, people with a lower functional status, and those with disability had more PSA problems. Time since discharge was not correlated with uncertainty or PSA. Uncertainty was a strong predictor of PSA at both S1 and S2.

Conclusions: First-time ICD recipients who have greater uncertainty or less PSA at 1 week after hospital discharge may have more PSA problems during the first 2 months after implant. Age, education, and severity of illness may influence uncertainty and/or PSA. Further research is needed to determine the relationship between uncertainty and PSA over time.