Person-centered analysis of psychological traits to explain heterogeneity in patient-reported outcomes of coronary artery disease- the THORESCI study

Eveline van Montfort; Nina Kupper; Jos Widdershoven; Johan Denollet

doi:10.1016/j.jad.2018.04.072

Person-centered analysis of psychological traits to explain heterogeneity in patient-reported outcomes of coronary artery disease- the THORESCI study

J Affect Disord. 2018 Aug 15:236:14-22. doi: 10.1016/j.jad.2018.04.072. Epub 2018 Apr 18.

Authors

Eveline van Montfort¹, Nina Kupper², Jos Widdershoven³, Johan Denollet⁴

Affiliations

¹ Center of Research on Psychological and Somatic Disorders, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands. Electronic address: e.m.j.vanmontfort@tilburguniversity.edu.
² Center of Research on Psychological and Somatic Disorders, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands. Electronic address: h.m.kupper@tilburguniversity.edu.
³ Center of Research on Psychological and Somatic Disorders, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands; Elisabeth Tweesteden Hospital, Doctor Deelenlaan 5, 5042 AD Tilburg, the Netherlands. Electronic address: jwiddershoven@etz.nl.
⁴ Center of Research on Psychological and Somatic Disorders, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands. Electronic address: j.denollet@tilburguniversity.edu.

PMID: 29704656
DOI: 10.1016/j.jad.2018.04.072

Abstract

Background: Heterogeneity in the prognosis of coronary artery disease (CAD) patients may be explained by relatively stable individual psychological differences. Therefore, we studied multiple personality and coping traits using a person-centered approach, and examined the predictive value of this approach for patient-reported outcomes.

Method: 657 CAD patients (age = 66.39 ± 10.6; 79% men) completed multiple self-report questionnaires focusing on demographics, negative affectivity and social inhibition (DS14), neuroticism and extraversion (EPQ), resilience (DRS-15), and coping styles (CISS) after undergoing percutaneous coronary intervention. Depressive symptoms (PHQ-9), anxiety (GAD-7), and treatment adherence (MOS) were assessed at 6 months follow-up. Clinical information was extracted from patients' medical records.

Results: A step-3 latent class analysis identified four subgroup profiles: Low distress (31%), Passive coping (21%), Active coping (20%), and High distress (28%). For all patient-reported outcomes, overall significant differences between the subgroups were observed (p-values < .05). The High distress profile was associated with the highest levels of emotional distress (d's > .94), and lowest levels of positive mood (d = -1.02) and treatment adherence (d = -2.75) at follow-up. Patients with an Active coping profile also experienced increased emotional distress (d's > .50), but participated in cardiac rehabilitation most often (d = .13), and reported high levels of positive mood (d = -1.02). Patients with a Passive coping profile displayed few emotional problems after six months (d's < .30), but participation to cardiac rehabilitation was relatively low (d = .04).

Conclusions: This study revealed four distinct psychological latent subgroups, which were predictive of patient-reported outcomes. The results indicate that a person-centered approach is useful in explaining heterogeneity in recovery from PCI, and may enhance personalized medicine in patients with CAD.

Keywords: Coping styles; Coronary artery disease; Latent class analysis; Person-centered; Personality; Psychological profiles; Variable-centered.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological*
Aged
Anxiety / psychology
Coronary Artery Disease / psychology*
Coronary Artery Disease / surgery
Depression / psychology
Emotions
Female
Humans
Latent Class Analysis
Male
Middle Aged
Patient Reported Outcome Measures*
Percutaneous Coronary Intervention / psychology*
Postoperative Period
Stress, Psychological / psychology*
Surveys and Questionnaires