Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T20:15:21.519Z Has data issue: false hasContentIssue false
  • English
  • Français

Exhaustion, depression and hopelessness in cardiac patients: a unidimensional hierarchy of symptoms revealed by Mokken scaling

Published online by Cambridge University Press:  13 June 2014

Frank Doyle ,
Aleksandra Kowalczyk ,
Hannah McGee  and
Ronán M Conroy
Frank Doyle
Affiliation:
Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
Aleksandra Kowalczyk
Affiliation:
Trinity College Dublin
Hannah McGee
Affiliation:
Faculty of Medicine and Health Sciences, RCSI
Ronán M Conroy*
Affiliation:
Epidemiology & Public Health Medicine, Division of Population Health Sciences, RCSI, Dublin 2, Ireland
*
*Correspondence Email: fdoyle4@rcsi.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Depression and vital exhaustion are associated with poor cardiovascular prognosis, but there is substantial overlap between these constructs. Factor analytic studies have been inconclusive, and may not be the optimal analytic strategy to assess dimensionality. We assessed whether exhaustion and depression formed a single, hierarchical dimension using a form of nonparametric item response theory.

Methods: Patients with acute coronary syndrome (n = 430) completed questionnaires assessing depression and vital exhaustion. Mokken scaling was used to assess dimensionality.

Results: Mokken scaling formed a strong unidimensional scale, ordered in a hierarchy reflecting prevalence: fatigue (common), depression (less common) and hopelessness (rare).

Conclusions: Depressive symptoms form a clear hierarchy in cardiac patients, from fatigue to hopelessness. Vital exhaustion may be considered a less severe form of depression. Use of hierarchical scales may allow clinicians to better determine clinical significance and target interventions.

Keywords

DepressionMokken scalingCoronary artery diseaseItem response theoryFatigue
Type
Brief Reports
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 1 , March 2011 , pp. 29 - 31
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Thombs, BD, Bass, EB, Ford, DE, Stewart, KJ, Tsilidis, KK, Patel, U, et al.Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006;21(1):30–38.CrossRefGoogle ScholarPubMed
2.van Melle, JP, de Jonge, P, Spijkerman, TA, Tijssen, JG, Ormel, J, van Veldhuisen, DJ, et al.Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004;66(6):814–822.CrossRefGoogle ScholarPubMed
3.Appels, A. Exhaustion and coronary heart disease: the history of a scientific quest. Patient Educ Counsel 2004;55(2):223–229.CrossRefGoogle ScholarPubMed
4.Appels, A, Falger, PR, Schouten, EG. Vital exhaustion as risk indicator for myocardial infarction in women. J Psychosom Res 1993;37(8):881–90.CrossRefGoogle ScholarPubMed
5.Doyle, F, Conroy, R, McGee, H. Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality? Health Psychol Rev 2007;1(2):137–172.CrossRefGoogle Scholar
6.Papakostas, GI, Petersen, T, Homberger, CH, Green, CH, Smith, J, Alpert, JE, et al.Hopelessness as a predictor of non-response to fluoxetine in major depressive disorder. Ann Clin Psychiat 2007;19(1):5–8.CrossRefGoogle ScholarPubMed
7.Joiner, TE Jr., Cook, JM, Hersen, M, Gordon, KH. Double depression in older adult psychiatric outpatients: hopelessness as a defining feature. J Affect Disord 2007;101(1–3):235–8.CrossRefGoogle ScholarPubMed
8.Kudielka, BM, von Kanel, R, Gander, ML, Fischer, JE. The interrelationship of psychosocial risk factors for coronary artery disease in a working population: do we measure distinct or overlapping psychological concepts? Beh Med 2004;30(1):35–43.CrossRefGoogle ScholarPubMed
9.Wojciechowski, FL, Strik, JJ, Falger, P, Lousberg, R, Honig, A. The relationship between depressive and vital exhaustion symptomatology post-myocardial infarction. Acta Psychiat Scandin 2000;102(5):359–365.CrossRefGoogle ScholarPubMed
10.McGowan, L, Dickens, C, Percival, C, Douglas, J, Tomenson, B, Creed, F. The relationship between vital exhaustion, depression and comorbid illnesses in patients following first myocardial infarction. J Psychosom Res 2004;57(2):183–188.CrossRefGoogle ScholarPubMed
11.Embretson, SE, Reise, SP. Item response theory for psychologists. Mahwah, New Jersey: Lawrence Erlbaum Associates, 2000.Google Scholar
12.Meijer, RR, Baneke, JJ. Analyzing psychopathology items: a case for nonparametric item response theory modeling. Psychol Method 2004;9(3):354–368.CrossRefGoogle ScholarPubMed
13.Doyle, F, Conroy, RM, McGee, HM, Delaney, M. Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis. Psychosom Res 2010;68:121–130.CrossRefGoogle ScholarPubMed
14.Beck, AT, Steer, RA, Brown, GK. Manual for the Beck Depression Inventory-Fast Screen for Medical Patients. San Antonio, TX: Psychological Corporation, 2000.Google Scholar
15.Scheinthal, SM, Steer, RA, Giffin, L, Beck, AT. Evaluating geriatric medical outpatients with the Beck Depression Inventory-Fastscreen for medical patients. Aging Ment Health 2001;5(2):143–148.CrossRefGoogle ScholarPubMed
16.McGee, HM, Doyle, F, Conroy, RM, De La Harpe, D, Shelley, E. Impact of briefly-assessed depression on secondary prevention outcomes after acute coronary syndrome: a one-year longitudinal survey. BMC Health Serv Res 2006;6:9.CrossRefGoogle ScholarPubMed
17.Meesters, C, Appels, A. An interview to measure vital exhaustion. I. Development and comparison with the Maastricht Questionnaire. Psychol Health 1996;11(4):557–571.CrossRefGoogle Scholar
18.Appels, A. Een korte stresstest voor de poliklinische situatie. Hart Bulletin 2001;32(1):8–10.Google Scholar
19.Stata Statistical Software: Release 9 [program]. 9.2 version. College Station, TX: StataCorp LP, 2005.Google Scholar
20.MSP: Stata module to perform the Mokken Scale Procedure [program]: Boston College Department of Economics, 2004.Google Scholar
21.Appels, A, Bar, F, van der Pol, G, Erdman, R, Assman, M, Trijsburg, W, et al.Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT). Psychosom Med 2005;67(2):217–223.CrossRefGoogle ScholarPubMed
22.Spijkerman, TA, van den Brink, RH, Jansen, JH, Crijns, HJ, Ormel, J. Who is at risk of post-MI depressive symptoms? J Psychosom Res 2005;58(5):425–432; discussion 433-434.CrossRefGoogle ScholarPubMed
23.Pedersen, SS, Denollet, J, Daemen, J, van de Sande, M, de Jaegere, PT, Serruys, PW, et al.Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents. J Psychosom Res 2007;62(4):455–461.CrossRefGoogle ScholarPubMed
24.The ENRICHD Investigators. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289(23):3106–3116.CrossRefGoogle Scholar
25.de Jonge, P, Ormel, J, van den Brink, RH, van Melle, JP, Spijkerman, TA, Kuijper, A, et al.Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. Am J Psychiat 2006;163(1):138–144.CrossRefGoogle ScholarPubMed