Thousands of people have defibrillators. These devices are implanted in the chest wall and deliver electric impulses that stimulate the heart muscle and help it maintain a normal rhythm. The surgical procedure required to implant a defibrillator is invasive, but the trauma experienced by the patient comes not only from the surgery, but from the fear that the defibrillator may stop working. This can lead to posttraumatic stress, depression, and anxiety, problems that are present in nearly half of defibrillator recipients in the year following surgery. And although these individuals receive continual care for their cardiac health, they often do not receive adequate care for their psychological issues. Chronic mental health problems can decrease quality of life and lead to poor physical health, repeat cardiac events, and potentially death.
Madelein T. Hoogwegt of the Center of Research on Psychology in Somatic Diseases at Tilburg University in the Netherlands wanted to get a clearer picture of what percentage of defibrillator recipients were experiencing psychological distress, how many were receiving treatment, and whether that treatment was helping. In a recent study, Hoogwegt followed 448 patients in the first year after they received a defibrillator. At the time of surgery, more than one-third were distressed, but fewer than one-third of those distressed patients were receiving treatment. Twelve months after surgery, one in four had distress. Of those, 58% were not receiving any psychological treatment, and they reported a lower quality of health than those with no distress.
Surprisingly, participants with distress who were receiving treatment exhibited the worst outcomes mentally and physically. Hoogwegt believes this could be due to the type of treatment they were receiving. The majority of the participants in treatment were receiving only psychotropic medication and not therapy. Because the distress associated with heart problems can be complex, Hoogwegt believes individual therapy from a psychologist or counselor could better address the unique issues these people face. The findings presented here highlight the need for further exploration into why these patients are not seeking or receiving the type of care that may best help them overcome their distress. “Importantly, emotional distress that is untreated may have a detrimental influence on health status, which in turn may increase the risk of morbidity and mortality in this subset of patients,” Hoogwegt said.
Hoogwegt, Madelein T., Nina Kupper, Dominic AMJ Theuns, Wobbe P. Zijlstra, Luc Jordaens, and Susanne S. Pedersen. Undertreatment of anxiety and depression in patients with an implantable cardioverter-defibrillator: Impact on health status. Health Psychology 31.6 (2012): 745-53. Print.
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