In collaboration with Payame Noor University and Iranian Health Psychology

Document Type : research


Assistant professor of Health psychology, Department of clinical psychology, Qom branch, Islamic Azad University, Qom, Iran.


Objective: Due to unpleasant consequences of depression in patients suffering from cardiac diseases, such as increase in mortality rate during the first year, especially after undergoing a surgery; this study addresses structural relationships between cognitive and behavioral variables including illness perception and coping strategies in predicting depression after undergoing Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI). Besides, one of the cognitive models for assessing psychological adaptation with chronic medical diseases was outlined for the first time. Method: The sample comprised 245 coronary patients confronted with the diagnosis for the first time, who had undergone PCI and CABG interventions. They were chosen and interviewed through convenience sampling following one month of initiating treatment process. For this purpose, Beck Depression Inventory for Primary Care (BDI-PC), Coping Inventory for Stressful Situations (CISS-21) and the short format of Disease Perception Questionnaire were administered. Data was analyzed using structural equations modeling (LISREL software). Results: findings indicated that applying emotion-focused coping strategies determined 40% of depression variance in these patients, whereas problem-focused strategies determined 4.5% of it and avoidant coping strategy didn’t have a significant role in depression. On the other hand, illness perception as a cognitive variable, could directly determine 26% of depression and 4.5% of it through emotion-focused strategies and 0.25% by means of problem-focused strategies. Also illness perception, could meaningfully determine 50% of emotion-focused coping variance, 7% of problem-focused variance and 8% of avoidance variance. Conclusion: Overall results of this study supported Leventhal’s theoretical model of self-regulation and verified the role of cognitive variables (illness perception) and behavioral ones (coping strategy) in emerging depression. Therefore it is recommended that much attention be drawn to the process of developing patient’s illness perception through personal or group trainings and if necessary, offering effective cognitive and behavioral treatments by practitioners.


Article Title [Persian]

افسردگی پس از بیماریهای عروق کرونر قلب: نقش ادراک بیماری و راهبردهای مقابله

Author [Persian]

  • نادر منیرپور

استادیار روانشناسی سلامت دانشگاه آزاد قم

Abstract [Persian]

هدف: با توجه به پیامدهای ناخوشایند افسردگی در بیماران مبتلا به بیماریهای قلبی، نظیر افزایش میزان مرگ و میر طی سال اول ابتلا، به ویژه پس از جراحی، مطالعه ی حاضر به بررسی روابط ساختاری متغیرهای شناختی و رفتاری شامل ادراک بیماری و راهبردهای مقابله در پیش بینی افسردگی پس از جراحی بای پس عروق کرونر و آنژیوپلاستی عروق کرونر پرداخت. بعلاوه، یکی از مدلهای شناختی سازگاری با بیماریهای مزمن طبی برای نخستین بار مورد بازآزمایی قرار گرفت. روش: 245 بیمار تحت جراحی بای پس عروق کرونری و آنژوپلاستی عروق کرونر که برای نخستین بار تشخیص بیماری را دریافت کرده بودند، به روش نمونه گیری دردسترس انتخاب شدند. آنها یک ماه پس از مداخلات درمانی مورد ارزیابی قرار گرفتند. برای این منظور آنها پرسشنامه افسردگی بک برای مراقبت های اولیه (BDI-PC)، پرسشنامه مقابله با موقعیت های استرس زا (CISS-21) و فرم کوتاه پرسشنامه ی ادراک بیماری را تکمیل نمودند. داده ها با استفاده از مدلیابی معادلات ساختاری (نرم افزار لیزرل) مورد تجزیه و تحلیل قرار گرفتند. نتایج: یافته ها نشان داد که استفاده از راهبردهای مقابله هیجان محور 40 درصد از واریانس افسردگی در این بیماران را پیش بینی می کنند، در حالی که راهبردهای مساله محور 4.5 درصد از آن را پیش بینی نمود، و راهبردهای احتناب سهم موثری در پیش بینی افسردگی را نداشتند. از طرف دیگر، ادراک بیماری به عنوان یک متغیر شناختی، مستقیما 26 درصد و به واسطه ی مقابله ی هیجان محور 4.5 درصد و به واسطه ی مقابله مساله محور 0.25 درصد از افسردگی را تبیین نمود.همچنین، ادراک بیماری 50 درصد از واریانس مقابله هیجان محور و 7 درصد از از واریانس مقابله مساله محور و 8 درصد از واریانس مقابله اجتناب را تبیین نمود. نتیجه گیریبه طور کلی نتایج این مطالعه از مدل نظری خودتنظیمی لونتال حمایت نموده و نقش متغیرهای شناختی (ادراک بیماری) و رفتاری (راهبردهای مقابله) را در ایجاد افسردگی تایید می کند. بنابراین، پیشنهاد می شود که فرایند توسعهی ادراک بیماری از طریق آموزش های فردی یا گروهی مورد توجه قرار گیرد، و در صورت لزوم مداخلات شناختی و رفتاری موثر در دستور کار متخصصان قرار گیرد.

Keywords [Persian]

  • افسردگی پس از بیماری های عروق کرونر قلب
  • ادراک بیماری
  • راهبردهای مقابله
  • جراحی بای پس عروق کرونر
  • آنژیوپلاستی عروق کرونر
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