A Mixed-method Study Of Psychosocial Adjustment Among Young And Middle-aged Patients After Coronary Stent Implantation

ObjectiveTo investigate psychosocial adjustment status and to explore its various influencing factors of young and middle-aged patients after coronary stent implantation by a descriptive research.And to deeply understand the experience of psychosocial adjustment of young and middle-aged patients after coronary stent implantation by a phenomenological research,clarifying the common problems of their psychosocial adjustment and coping strategies.It provides a theoretical basis for clinical staffs to improve the understanding of psychosocial adjustment status and its influencing factors,and to carry out psychosocial interventions for better rehabilitation among young and middle-aged patients after coronary stent implantation.MethodsThe following questionnaires were administered to 236 young and middle-aged patients after coronary stent implantation:general questionnaire,PAIS-SR,CD-RISC and SSRS from Sept.2019 to Sept.2020.In the qualitative study,phenomenological research method was adopted to conduct semi-structured interviews among 8 young and middle-aged patients after coronary stent implantation.Univariate analysis,correlation analysis and hierarchical regression analysis were used to assess the relationship between influencing factors and psychosocial adjustment of young and middle-aged patients after coronary stent implantation.Colaizzi analysis method was used to analyze the interview data.ResultsResults of the quantitative study:the mean score for psychosocial adjustment was55.63(SD=18.81),which corresponding to a medium level.There was no significant difference in scores between young and middle-aged patient(P=0.79).Pearson relation analysis revealed a significant association between resilience,social support and psychosocial adjustment among young and middle-aged patients after coronary stent implantation(P<0.001).Univariable analysis showed bad economic status,irregular exercise habits,present of smoking,the frequent need to care for parents with chronic diseases,limited cardiac function and diabetic presented with higher level of psychosocial problems both in young and middle-aged patients(P<0.05).The results of regression analysis showed resilience,social support and diabetes were the predictors of psychosocial adjustment of young patients after coronary stent implantation(R~2=0.733,P<0.001).Cardiac function,frequent need to care for parents with chronic diseases,resilience and social support were identified as predictors of level of the psychosocial adjustment among middle-aged patients after coronary stent implantation(R~2=0.617,P<0.001).Results of qualitative study:(1)Adaptive challenges faced by young and middle-aged patients after coronary stent implantation,including difficulties of individual adaptation,influence on family members and life,negative influence of peers and lack of social support resources.Difficulties of individual adaptation include physical reactions,negative emotions,poor self-management,reduced work capacity,financial stress and reduced social activities.Influence on family members and life include family incomprehension,problems on sexual activities and role conflict.Inadequate social support resources include negative peer influence and lack of professional follow-up and guidance.(2)Adaptive experience of psychosocial adjustment among young and middle-aged patients after coronary stent implantation,including self-adjustment,understanding and support from friends and family members,and medical insurance.Conclusion1.In this study,psychosocial adjustment of young and middle-aged patients after coronary stent implantation was at medium level.2.Social support and psychological resilience are the common positive factors of psychosocial adjustment among young and middle-aged patients after coronary stent implantation.Higher level of social support and psychological resilience will promote their psychosocial adjustment after coronary stent implantation.Diabetes was the negative factor of the psychosocial adjustment in young patients.Limited cardiac function,frequent need to take care of parents with chronic diseases were the negative factors of the psychosocial adjustment in middle-aged patients.3.Adaptive challenges faced by young and middle-aged patients after coronary stent implantation,including including difficulties of individual adaptation,influence on family members and life,and lack of social support resources.Adaptive experience of psychosocial adjustment among young and middle-aged patients after coronary stent implantation,including self-adjustment,understanding and support from friends and family members,and medical insurance.4.The significance of this study:Young and middle-aged adults are the prime of society and family.The adverse psychosocial problems of patients after coronary stent implantation will not only hinder the successful return to family and society,but also affect the quality and outcome of the disease,bringing huge economic pressure and wealth loss to the family and society.Therefore,improving the level of psychosocial adjustment is conductive to helping patients return to family and society successfully,improving the quality of life after coronary stent implantation.