The Relationship Between Type A And Type D Personality And Poor Prognosis Of Coronary Heart Disease And The Effect Of Psychological Intervention

Objective:(1) To explore the relationship of type A personality?type D personlity? negative mood? emotional expressivity?physiological risk factor with adverse prognosis and risk selustering, set up struetural equation mode of influence from type A personality?type D personlity to physiological risk factor and adverse prognosis, to integrate effect form type A personality?type D personlity to CDH adverse prognosis, provide theory evidence for further theory research and psychological intervention research.(2) lay down psychological intervention tactics, To explore it's efect to type A personality?type D personlity?Negative Mood, provide evidence for further intervention research and clicical practice.Method:(1)236patients with CHD and196normative subjects were included in the study, and they all fllled out the following scales:Demographics questionnair, DS14,SAS,SDS,PSSS and EES, CHD Patients were administered clinical examination, including Blood Pressure, Heart Rate, Fasting Plasma Glucose, Blood fat, Body Mass Index, C-reactive Protein, Coronary Arteriography, reliability and validity of DS14were calculated, Compared the results of psychology test and clinical dates of CHD patients by t test and x2test. The hierarchieal multiple regression analyses were Performed to examine the Predietability of the type A personlity?type D personlity?other psychology variable and physiological risk factor for the rate of clustering of CHD risk factors.The analyses of SEM were used to investigate the Possible mechanisms and ways of the adverse prognosis induced by Type A and type D Personality in CHD patients.(2) psychological Intervention strategy were established according to results of study I,25CHD patients with study group were selected, and25patients were selected with control group, study group were intervented and evaluated by TAS-C,DS14,SAS,SDS,PSSS and EES.Result:(1) The Cronbach's a coeffieients of the DS14was0.857, split half reliability was0.701, construct reliability was0.782; A confirmatory factor analysis provided a good fit for a two-factors model (withx2/df<5?CFI?IFI?GFI>0.90,RMSEA<0.081), the correlation coefficient of TH with the total score of DS14was0.268(p<0.01), the correlation coefficient of TAC-C? SDA?SAS?EES with the total score of DS14were0.231?0.388?0.375?-0.255(p<0.01), the correlation coefficient of NA with TH?CH?TAC-C?SDS and SAS were0.381?0.332?0.379?0.445(p<0.01), the correlation coefficient of SI with SDS?SAS and EES are0.222?0.323?-0.359(p<0.01) (2) The score of TAS-C?DS-SL?DS14?SDS?SAS of CHD patients were higher than normative subjects (p<0.01, p<0.05), the score of family supportion of CHD patients was lower than normative subjects (p<0.01).the rate of person with type A personlity in CHD patients was higher than one in normative subjects (p<0.01), there was no significant difference between the rate of person with type D personlity in two groups (p>0.05), the score of TAS-C-CH and PSSS of male CHD patients were higher than female's score (p<0.05), the score of SDS and SAS of male CHD patients were lower than female's score (p<0.01, p<0.05), the score of DS-NA?DS14of patients with type A personlity were higher than it of patients without type A personlity (p<0.01, p<0.05)(3)The score of SDS and SAS of CHD patients with type D personlity were higher than it of CHD patients without type D personlity (p<0.01,p<0.05). The score of SAS of male patients is lower than female patients in CHD patients with type A personlity (p<0.05),to the patients without type A personlity, the score of TAS-C-CH of male was higher than it of female (p<0.01).The score of SDS of male was lower than it of female in patients with type D personlity (p<0.05),but the score of DAS of male was lower than female (p<0.01)(4) The average smoking histroy in patients with type A personlity was longer than it in patients without type A personlity (p<0.01), the everage time in weekly physical exercise of CHD patients without type D personlity was longer than ones with type D personlity (p<0.01),the systolic pressure and Homocysteine of CHD patients with type D personlity were higher than it of CHD patients without type D personlity (p<0.01,p<0.05)(5)There were positive correlation between score of TH and score of NA? DS14-SI?DS14CH?SDS (p<0.05, p<0.01), the correlation between score of TH and score of family support was negative (with r=-0.281), there was positive correlation between score of CH and Emotional Expressivity (p<0.01), there were positive correlation between score of TAC and NA?DS14?SAS?EES,(p<0.05,p<0.01), the correlation between score of TAC and family support is negative (p<0.01); there were positive correlation between score of NA and SI?SAS? EES in CHD patients (p<0.01), there were negative correlation between score of NA and family?PSSS (p<0.01), there were positive correlation between score of SI and SAS?SDS in CHD patients (p<0.01), there were negative correlation between score of SI and family?PSSS?EES (p<0.01) (6) there were positive correlation between score of TH?CH?TAC?SI and felustering of CHD risk factor in CHD patients (p<0.05,P<0.01), there were positive correlation between score of TH?CH?TAC?NA?SI?DS14and severity of coronary lesions in CHD patients (p<0.01), multiple regression analysis showed that TH and NA had a close correlation with felustering of CHD risk factor(p<0.01,p<0.05), Predictability of CH and SI to felustering of CHD risk factor wasn't effective (p>0.05).TH and SI had a close correlation with severity of coronary lesions in CHD patients(p<0.05), Predictability of CH and NA to severity of coronary lesions wasn't effective (p>0.05)(7)The analysis result of best structural equation modeling shows that type A personlity and type D personlity exert indirect influence on adverse prognosis through the physiological mechanism. Effective coefficient B of type A personlity to physiological risk factor is0.46, Effective coefficient B of type D personlity to physiological risk factor is0.38, physiological risk factor exert direct influence on adverse prognosis(B=0.88, p<0.01).(8)Result of psychological intervention shows that the scores of TH?CH?TAC-C of study group decreased after psychological intervention(p<0.01?p<0.05), there was difference between scores of CH?TAC-C of study group and control group after intervention (p<0.05), the scores of NA?DS14of study group decreased after psychological intervention (p<0.01), the score of SI did not change after intervention(p>0.05), the score of NA of study group lower than it of control group (p<0.01), there was no difference of SI and DS14between two groups.(9)the scores of SDS and SAS decreased after psychological intervention (p<0.01),the score of SDS of study group was lower than control group(p<0.01),the factor of nagative Affect Intensity?positive affect intensity?calm emotional model and emotional expressivity improved after psychology intervention (p<0.01), there were difference between two groups on nagative Affect Intensity?calm emotional model and emotional expressivity (p<0.01)Conclusion:(1)Type A personlity and type D personlity exert indirect influence on adverse prognosis through the physiological risk factor. The influence effect of Type A personlity with physiological risk factor is stronger than type D personlity.(2)there is improved effect of psychological intervention for type A personlity?type D personlity?nagative emotion and emotional expressivity, but there is no improved effect for Social Inhibition of CHD patients.