The Role of Defense Styles and Alexithymia on Predicting Quality of Life in Patients with Coronary Heart Disease

Background and Objective: Paying attention to quality of life in patients with coronary heart disease due to the extent of damage and mortality is of importance. The present study investigated the role of defense styles and alexithymia on predicting quality of life in patients with coronary heart disease. Materials and Methods:In this cross-sectional descriptive study, ۳۰۰ patients with coronary heart disease who attended Heart Center of Shahid Ayatollah Madani Hospital in Lorestan, Iran, were selected by convenience sampling method from May to October, ۲۰۱۳. Data was collected using Demographic Questionnaire, Defense Style Questionnaire (DSQ-۴۰), Toronto Alexithymia Scale (TAS-۲۰) and The MacNew Heart Disease Health Related Quality of Life (HRQL) instruments. A stepwise multiple regression procedure was used for data analysis withSPSS version ۱۹. Results: There was no significant correlation between mature defense styles and quality of life (P=۰.۱۹۸).In addition, a significant (negative) correlation was found between neurotic and immature defense styles and quality of life (p<۰.۰۱). Meanwhile, a significant (negative) correlation was found between alexithymia components and quality of life (p<۰.۰۵). The results of multiple regression analysis showed that immature defense styles and difficulty in identifying feelings are able to predict a reduction in quality of life in patients with coronary heart disease (p<۰.۰۰۰۵). Conclusion: Immature defense styles and difficulty in identifying feelings play an important role in predicting quality of life in patients with coronary heart disease. Therefore, in order to improve the quality of life in these patients, attention to the aforementioned variables during clinical trials with the goal of appropriate intervention will be beneficial. References ۱- Polikandrioti M, Babatsikou F. Information to coronary disease patients. Health Sci J. ۲۰۱۳ ۷: ۳-۱۰. ۲- Global status report on noncommunicable diseases ۲۰۱۰. Geneva, World Health Organization. ۲۰۱۱. ۳- Foxwell R, Morley C, Frizelle D. Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients. J Psychosom Res. ۲۰۱۳ ۷۵: ۲۱۱-۲۲. ۴- Loughlin C, Murphy N, Conlon C. Quality of life predicts outcome in a heart failure disease management program. Int J Cardiol. ۲۰۱۰ ۱۳۹: ۶۰-۷. ۵- Rassart J, Luyckx K, Goossens E, Apers S, Klimstra TA, Moons P. Personality traits, quality of life and perceived health in adolescents with congenital heart disease. Psychol Health. ۲۰۱۳ ۲۸: ۳۱۹-۳۵. ۶- Ghasemi E, Mohammad Aliha J, Bastani F, Haghani H, Samiei N. Quality of life in women with coronary artery disease. Iran Red Crescent Med J. ۲۰۱۴ ۱۶:e۱۰۱۸۸. ۷- Carvalho A, Ramırez S, Macedo D. The psychological defensive profile of hemodialysis patients and its relationship to health-related quality of life. J Nerv Ment Dis. ۲۰۱۳ ۲۰۱: ۶۲۱-۲۸. ۸- Nardelli S, Pentassuglio I, Pasquale C. Depression, anxiety and alexithymia symptoms are major determinants of health related quality of life (HRQoL) in cirrhotic patients. Metab Brain Dis. ۲۰۱۳ ۲۸: ۲۳۹-۴۳. ۹- Brady S, Carson C. Brief report: self-harm is associated with immature defense mechanisms but not substance use in a nonclinical Scottish adolescent sample. J Adolesc. ۲۰۱۲ ۳۵: ۷۶۵-۷. ۱۰- Malone J, Cohen S, Liu S, Vaillant G, Waldinger R. Adaptive midlife defense mechanisms and late-life health. Pers Individ Dif. ۲۰۱۳ ۵۵: ۸۵-۹. ۱۱- Hyphantis T, Goulia P, Carvalho A. Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J Psychosom Res. ۲۰۱۳ ۷۵: ۳۶۲-۶۹. ۱۲- Martinez BPR, Leon EC, Rodriguez GAR, Moctezuma LGP. Defense mechanisms in cardiovascular disease patients with and without panic disorder. Salud Mental. ۲۰۱۰ ۳۳: ۲۱۹-۲۷. ۱۳- Komaki G. somatization and psychosomatic symptoms. New York: Sperliger. ۲۰۱۳. ۱۴- Preti A, Sancassiani F, Cadoni F, Carta M. Alexithymia affects pre-hospital delay of patients with acute myocardial infarction: Meta-analysis of existing studies. Clin Pract Epidemiol Ment Health. ۲۰۱۳ ۹: ۶۹-۷۳. ۱۵- Grabe HJ, Schwahn C, Barnow S, et al. Alexithymia, hypertension, and subclinical atherosclerosis in the general population. J Psychosom Res. ۲۰۱۰ ۶۸: ۱۳۹-۴۷. ۱۶- Valkamo M, Hintikka J, Honkalampi K, Niskanen L, Koivumaa-Honkanen H, ViinamaÈki H. Alexithymia in patients with coronary heart disease. J Psychosom Res. ۲۰۰۱ ۵۰: ۱۲۵-۳۰. ۱۷- Hofer S, Saleem A, Stone J, Thomas R, Tulloch H, Oldridge N. The macnew heart disease health-related quality of life questionnaire in patients with angina and patients with ischemic heart failure. Value Health. ۲۰۱۲ ۱۵: ۱۴۳-۵۰. ۱۸- Asadi-Lari M, Javadi HR, Melville M, Oldrige N, Gray D. Adaptation of the Macnew quality of life questionnaire after myocardial infarction in an Iranian population . Health Qual Life Outcomes. ۲۰۰۳ ۱: ۲۳. ۱۹- Andrews G, Singh M, Bond M. The defense style questionnaire. J Nerv Ment Dis. ۱۹۹۳: ۱۸۱ ۲۴۶-۵۶. ۲۰- Besharat MA. Reliability and factorial validity of farsi version of the ego mechanisms of defense scale with a sample of Iranian students. Psychol Rep. ۲۰۰۷ ۱۰۱: ۲۰۹-۲۲. [In Persian] ۲۱- Heidarinasab l, Mansoor M, Azadfalah P, Shaery, MR. The Validity and reliability of the defense style questionnaire in Iranian sample. Daneshvar. ۲۰۰۷ ۱۴: ۱۱-۲۷. [In Persian] ۲۲- Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto alexithymia scale-I: item selection and cross-validation of the factor structure. J Psychosom Res. ۱۹۹۴ ۳۸: ۲۳-۳۲. ۲۳- Ghorbani N, Bing MN, Watson PJ, Davison HK, Mack DA. Self-reported emotional intelligence: construct similarity and functional dissimilarity of higher-order processing in Iran and United-States. Int J Psychol, ۲۰۰۲ ۳۷: ۲۹۷- ۳۰۸. ۲۴- Modestin J, Furrer RM, Malti T. Study on alexithymia in adult non-patients. J Psychosom Res. ۲۰۰۴ ۵۶: ۷۰۷-۹. ۲۵- Albuquerque SA, Carvalho AR, Lopes RS, et al. Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity. Qual Life Res. ۲۰۱۱ ۲۰: ۱۴۰۱-۱۰. ۲۶- Goulia P, Voulgari PV, Tsifetaki N, Drosos AA, Hyphantis T. Comparison of health-related quality of life and associated psychological factors between younger and older patients with established rheumatic disorders. Aging Ment Health. ۲۰۱۰ ۱۴: ۸۱۹-۲۷. ۲۷- Hyphantis TN, Tomenso B, Bai M, Tsianos E, Mavreas V, Creed F. Psychological distress, somatization, and defense mechanisms associated with quality of life in inflammatory bowel disease patients. Dig Dis Sci. ۲۰۱۰ ۵۵: ۷۲۴-۳۲. ۲۸- Khosravani E, Mahmoodi-Rad GH, Dastjerdi R. The investigation of the relation of coping styles with quality of life and psychological well-being among cardiovascular patients. Fourth International Congress on Psychosomatic. Esfehan: Islamic Azad University of Khorasgan, ۲۰۱۲. ۲۹- Ali-Akbari Dehkordi M, Salehi S, Rezaee A. The comparison of illogical beliefs and defensive styles among heart coronary patients and healthy individuals. Health Psychol. ۲۰۱۳ ۲: ۱۸-۳۲. [In Persian] ۳۰- Mattila AK, Saarni SI, Salminen JK, Huhtala H, Sintonen H, Joukamaa M. Alexithymia and health-related quality of life in a general population. Psychosomatics. ۲۰۰۹ ۵۰: ۵۹-۶۸. ۳۱- Tselebis A, Kosmas E, Bratis A, et al. Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients. Ann Gen Psychiatry. ۲۰۱۰ ۹: ۱۶. ۳۲- Vieira RV, Vieira DC, Gomes WB, Gauer G. Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura. J Headache Pain. ۲۰۱۳ ۱۴: ۱۸. ۳۳- von Rimscha SV, Moergeli H, Weidt S, Straumann D, Hegemann S, Rufer M. Alexithymia and health-related quality of life in patients with dizziness. Psychopathology. ۲۰۱۳ ۴۶: ۳۷۷-۸۳. ۳۴- Vazquez I, S´andez E, Gonz´alez-Freire B, Romero-Frais E, Blanco-Aparicio, Verea-Hernando. The role of alexithymia in quality of life and health care use in asthma. J Asthma. ۲۰۱۰ ۴۷: ۷۹۷-۸۰۴. ۳۵- Steptoe A, Wikman A, Molloy G J, Messerli-Burgy N, Kaski JC. Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease. Brain Behav Immun. ۲۰۱۳ ۳۱: ۱۸۳-۸۸.

Keywords:

Keywords: Coronary heart disease , Quality of life , Defense styles , Alexithymia