الفهرس 
Acknowledgement
Myocardial infarctionOnly 14 pages are availabe for public view
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Abstract
Summary
Despite significant progress in the treatment of coronary artery disease, myocardial infarction is still the leading cause of death in many countries especially in the United States. It is estimated that 1.5 million persons in the United States had a myocardial infarction Each year, in the rate of one person has a heart attack every 29 seconds, and every 60 seconds one person dies because of a heart attack, The continued high morbidity and mortality of myocardial infarction may be due to a failure to address the role of psychosocial factors such as depression, and anxiety in the incidence of myocardial infarction and affect greatly in the recovery process, complication, recurrence, and at the end leads to mortality in spite of giving advanced treatment. The recent studies confirmed the role of interaction of physical and psychosocial factors related to morbidity after myocardial infarction. Myocardial infarction spread in the Arabian countries in the last years especially with the different problems of our life which full of psychological stressors and changes in life style, manner of eating, smoking and addiction, all of them leads to myocardial infarction.
The study aimed to:
Psychological assessment of patients with myocardial infarction.
subjects
The total study sample was 119 patients with myocardial infarction who accepted to participate in the study and gave an informed oral and written consent during one year period. The studied sample consisted of 64% (78) Males and 36% (41) Females This study has been carried out in cardiac outpatient clinic of Assiut University Hospital.
Data were collected through the following six tools:
1. Clinical data questionnaire (Appendix I):
It includes personal and clinical data. The personal data included patient’s ( name, age, sex, level of education, occupation, address). And the clinical data included (Diagnosis, present complains, onset of illness, predisposing factors, present treatment, family history, complication and life style changes).
2. Socio economic status data scale (Appendix II):.
This scale is designed by Abd-El-Tawab (2004) to assess socioeconomic status of the family and consists of 4 dimensions, which include the following:
- Parent’s level of education it included 8 items.
- Parent’s occupation it included 2 items.
- Total family monthly income it included 6 items.
- Life style of the family it included 3 items.
3-The symptom checklist-90-Revised (Elbehairy, 2004 (Appendix III)).
The SCL-90-R is a 90-item self-report symptom inventory developed by Clinical Psychometric Research. It is designed primarily to reflect the psychological symptom pattern of psychiatric and medical patients. A preliminary version of the scale was introduced by Derogatis and his colleagues (Derogatis et al., 1973) and based on early clinical experiences. Psychometric analysis was modified and validated in the revised (R) form (Derogatiset al., 1976).
Each item of the “ 90” is rated on a 5-point scale of distress (0-4), ranging from non-at-all at one pole to “extremely “ at the other pole .The “90” is scored and interpreted in terms of 9 primary symptom dimensions and 3 global indices of distress that are labeled:
1. Somatization.
2. Obsessive compulsive.
3. Interpersonal sensitivity.
4. Depression.
5. Anxiety.
6. Hostility.
7. Phobic anxiety.
8. Paranoid ideation.
9. Psychoticism.
4-Depression, Anxiety, Stress scale 42 (DASS-42) (Appendix IV)
Psychiatric properties of the Depression, Anxiety, Stress scale 42 items self report inventory that yields that 3 factors: Depression, Anxiety and Stress. This measure proposes that physical anxiety (fear symptomatology) and mental stress (nervous tension and nervous energy) factor- out as two distinct domains.
5-Beck depression inventory scale (Appendix V)
It was developed by Beck (1992), The Arabic version of Beck depression inventory scale which modified by Ghareeeb (1990). This scale is composed of (13 items) measured on points (0-3) likert scale each containing four statements ranked in order of severity, The patient chooses the statement closed to their present state.
6-Norbek Social Support Questionnaire(NSSQ) (Appendix VI)
The tool was originally developed by Norbeck et al. (1981) to measure patients social support. It is translated into Arabic language by Taha & Wehieda (1985) and used in different studies as Abd El-Aziz, et al, (1986). It includes 6 question, concerned with care and love, respect, confidence, support of thoughts or actions, short term financial aid and long term aid. The scale is rated from 1-5, for each question The sum of total scores in the response of the six question reveals if the patient receive good or bad social supportive net work.
The main results yielded by this study were:
1. The studied sample consisted of 119 patients. Males represent 65.6% while Females represents 34.4%. The mean age were 51.3±7.3 years 61.3 % of patients aged of 50 years or more which ranged from 40-75 years. As regard level of education most of patients (33.6%) were illiterate and 27.7% read and write 42% of them not working. Most of the studied sample (87.4%) are in the middle level of socioeconomic status and 57.1% live in urban areas. 59.7% of the total patients had bad social supportive net work.
2-Percentage of patients need clinical psychiatric intervention in order of frequency of symptoms 65.5% stomatization, 54.6% obsession, 45.4% anxiety, 44.5% phobia, 42.9% paranoia, 39.5% depression, 37.8% hostility, 37.8% sensitivity, 36.1% psychosis. Most of males are suffering from phobia (46.2%), depression (44.9%), sensitivity (41%) than females. Females have a higher percentage of hostility than males 41.5%.
3-About 69.7% of the total sample had depression, (70.7% of females and 69.2% of males). 31.9% of the total sample had severe depression (33.3% of males and 29.3% of females).
4- About 90.8% of the total sample had anxiety (92.3% of males, 87.8% of females). 59.7% of the total sample had extremely severe anxiety and 16.8% had severe anxiety. No statistical significance differences between sex and severity of anxiety.
5- About 67.2% of the total sample had stress, (66.7% of males and 68.8% of females), 37% of the total sample had severe stress and No statistical significance differences between sex and severity of stress.
6-As regards relationship between depression, anxiety, stress and social supportive net work, patients had bad social supportive network liable for depression, anxiety and stress than those had good social supportive net work. Patients had bad social supportive net work 33.8% of them had severe depression, 69% had extremely severe anxiety, 43.7% had severe stress.
7-As regards demographic characteristics of patients in relation to level of depression, anxiety and stress, patients with mild, moderate, severe depression, anxiety and stress were among patients older than 50 years old, married, not working, and in the low and middle social class