Psychological distress in cardiac rehabilitation participants

Limited data are available on the psychosocial characteristics of patients entering cardiac rehabilitation (CR). We characterized the psychological and clinical profiles of men and women entering CR to determine which, if any, characteristic identifies persons at high risk for psychological distress.

The records of 417 patients enrolled in phase II CR between January 2001 and December 2004 were analyzed. One hundred forty-eight of these patients underwent a comprehensive Symptom Checklist-90 psychological survey. The analysis focused on measures of depression, anxiety, hostility, somatization, and a global severity index.

Mean age of the patients was 60.6 years and 20.9% of them were women. More than one-third had a score of 90th percentile or more in at least 1 psychological category, and 23% had a score of 90th percentile or more in 3 or more categories. Approximately 20% and 36% of patients scoring in the 90th percentile or more and 98th percentile or more of depressive symptoms, respectively, had a history of depression. There was no difference in Symptom Checklist-90 scores by gender, age, education, work status, type of coronary event, metabolic syndrome, tobacco use, cerebrovascular disease, peripheral vascular disease, or diabetes. There was no relationship between psychological symptoms and indication for CR, although a trend of more somatic symptoms was seen in those who underwent an acute coronary syndrome and did not receive revascularization.

Considering the prevalence of psychological distress in CR patients and the lack of clinical identifiers, routine assessment could help identify those who are at increased risk of noncompliance and may benefit from psychological and/or pharmacological intervention.