Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T04:42:49.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Emotional distress and fatigue in coronary heart disease: the Global Mood Scale (GMS)

Published online by Cambridge University Press:  09 July 2009

Johan Denollet
Johan Denollet*
Affiliation:
Centre of Cardiac Rehabilitation, University Hospital of Antwerp, Belgium
*
1Address for correspondence: Dr Johan Denollet, UZA – Cardiale Revalidatie, Wilrijkstraat, 10, B-2650 Edegem, Belgium.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Evidence indicates that emotional distress has a long-term impact on morbidity and mortality in patients with coronary heart disease (CHD), and that symptoms of depression, fatigue, and reduced energy may identify high-risk patients. This study was designed to: (1) devise a sound and practical measure of emotional distress in CHD patients; (2) examine the relationship between emotional distress and fatigue following CHD; and (3) examine changes in emotional distress as a function of cardiac rehabilitation. A sample of 478 men with CHD (mean age = 57·8±8·7 y) filled out questionnaires 3–6 weeks following a myocardial infarction (N = 110), bypass surgery (N = 302), or coronary angioplasty (N = 66). Statistical analyses of 56 Dutch mood terms were used to produce the 20-item Global Mood Scale (GMS) which measures negative affect (characterized by fatigue and malaise), as well as positive affect (characterized by energy and sociability), in patients with CHD. The GMS was found to be a reliable scale (α > 0·90; r > 0·55 over a 3-month period), and correlations with existing measures of emotional functioning and self-deception indicated its convergent and discriminant validity. Most importantly, fatigue was not related to cardiorespiratory fitness in a subset of 140 patients, but clearly was associated with negative affect. Consistent with the self-efficacy model, scores on the GMS mood scales improved significantly as a function of rehabilitation (P < 0·0001). Although symptoms of emotional distress are easily explained away by situational factors, previous research suggests that failure to recognize the clinical significance of these symptoms in CHD patients may result in the delay of much needed intervention. The current findings suggest that the GMS is a theoretically and psychometrically sound measure of emotional distress in CHD patients, and that this scale is sufficiently sensitive to assess change.

Type
Original Articles
Information
Psychological Medicine , Volume 23 , Issue 1 , February 1993 , pp. 111 - 121
Copyright
Copyright © Cambridge University Press 1993

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

REFERENCES

Ahern, D. K., Gorkin, L., Anderson, J. L., Tierny, C., Hallstrom, A., Ewart, C., Capone, R. J., Schron, E., Kornfeld, D., Herd, J. A., Richardson, D. W. & Follick, M. J. (1990). Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). American Journal of Cardiology 66, 59–62.CrossRefGoogle ScholarPubMed
Alonzo, A. A., Simon, A. B. & Feinleib, M. (1975). Prodromata of myocardial infarction and sudden death. Circulation 52, 1056–1062.CrossRefGoogle ScholarPubMed
Appels, A. & Mulder, P. (1988). Excess fatigue as a precursor of myocardial infarction. European Heart Journal 9, 758–764.CrossRefGoogle ScholarPubMed
Blodgett, C. & Pekarik, G. (1987). Program evaluation in cardiac rehabilitation. I. Overview of evaluation issues. Journal of Cardiopulmonary Rehabilitation 7, 316–323.CrossRefGoogle Scholar
Blumenthal, J. A., Williams, R. S., Wallace, A. G., Williams, R. B. & Needles, T. L. (1982 a). Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction. Psychosomatic Medicine 44, 519–527.CrossRefGoogle ScholarPubMed
Blumenthal, J. A., Williams, R. S., Needles, T. L. & Wallace, A. G. (1982 b). Psychological changes accompany aerobic exercise in healthy middle-aged adults. Psychosomatic Medicine 44, 529–536.CrossRefGoogle ScholarPubMed
Blumenthal, J. A., Emery, C. F. & Rejeski, W. J. (1988). The effects of exercise training on psychosocial functioning after myocardial infarction. Journal of Cardiopulmonary Rehabilitation 8, 183–193.CrossRefGoogle Scholar
Booth-Kewley, S. & Friedman, H. S. (1987). Psychological predictors of heart disease: a quantitative review. Psychological Bulletin 101, 343–362.Google Scholar
Carney, R. M., Rich, M. W., Freedland, K. E., Saini, J., TeVelde, A., Simeone, C. & Clark, K. (1988). Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosomatic Medicine 50, 627–633.CrossRefGoogle ScholarPubMed
Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research 1, 245–276.CrossRefGoogle ScholarPubMed
Chen, M. K. (1986). The epidemiology of self-perceived fatigue among adults. Preventive Medicine 15, 74–81.CrossRefGoogle ScholarPubMed
Clark, L. A. & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology 100, 316–336.CrossRefGoogle ScholarPubMed
Crowne, D. P. & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology 24, 349–354.CrossRefGoogle ScholarPubMed
Croyle, R. T. & Uretsky, M. B. (1987). Effects of mood on self-appraisal of health status. Health Psychology 6, 239–253.CrossRefGoogle ScholarPubMed
De Backer, G., Kornitzer, M., Dramaix, M., Kittel, F., Thilly, C., Graffar, M. & Vuylsteek, K. (1988). The Belgian Heart Disease Prevention Project: 10-year mortality follow-up. European Heart Journal 9, 238–242.CrossRefGoogle ScholarPubMed
Denollet, J. (1991). Negative affectivity and repressive coping: pervasive influence on self-reported mood, health, and coronary-prone behavior. Psychosomatic Medicine 53, 538–556.CrossRefGoogle ScholarPubMed
Denollet, J. (1993). Biobehavioral research on coronary heart disease: Where is the person? Journal of Behavioral Medicine 16 (in the press).CrossRefGoogle ScholarPubMed
Denollet, J. & De Potter, B. (1992). Coping subtypes for men with coronary heart disease: Relationship to well-being, stress, and Type A behaviour. Psychological Medicine 22, 667–684.CrossRefGoogle ScholarPubMed
Dimsdale, J. E. (1991). A new mechanism linking stress to coronary pathophysiology? Circulation 84, 2201–2202.CrossRefGoogle ScholarPubMed
Dracup, K., Moser, D. K., Marsden, C., Taylor, S. E. & Guzy, P. M. (1991). Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function. American Journal of Cardiology 68, 31–34.CrossRefGoogle ScholarPubMed
Erdman, R. A., Duivenvoorden, H. J., Verhage, F., Kazemier, M. & Hugenholtz, P. G. (1986). Predictability of beneficial effects in cardiac rehabilitation: a randomized clinical trial of psychosocial variables. Journal of Cardiopulmonary Rehabilitation 6, 206–213.CrossRefGoogle Scholar
Frasure-Smith, N. (1991). In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. American Journal of Cardiology 67, 121–127.CrossRefGoogle ScholarPubMed
Gallacher, J. E. J. & Smith, G. D. (1989). A framework for the adaptation of psychological questionnaires for epidemiological use: an example of the Bortner Type A scale. Psychological Medicine 19, 709–717.CrossRefGoogle ScholarPubMed
Golino, P., Piscione, F., Willerson, J. T., Cappelli-Bigazzi, M., Focaccio, A., Villari, B., Indolfi, C., Russolillo, E., Condorelli, M. & Chiariello, M. (1991). Divergent effects of serotonin on coronary-artery dimensions and blood flow in patients with coronary atherosclerosis and control patients. New England Journal of Medicine 324, 641–648.CrossRefGoogle ScholarPubMed
Gotlib, I. H. & Meyer, J. P. (1986). Factor analysis of the Multiple Affect Adjective Check List: a separation of positive and negative affect. Journal of Personality and Social Psychology 50, 1161–1165.CrossRefGoogle Scholar
Grignani, G., Soffiantino, F., Zucchella, M., Pacchiarini, L., Tacconi, F., Bonomi, E., Pastoris, A., Sbaffi, A., Fratino, P. & Tavazzi, L. (1991). Platelet activation by emotional stress in patients with coronary artery disease. Circulation 83 (Suppl. II), II-128–II-136.Google ScholarPubMed
Guadagnoli, E. & Mor, V. (1989). Measuring cancer patients' affect: revision and psychometric properties of the Profile of Mood States (POMS). Psychological Assessment: A Journal of Consulting and Clinical Psychology 1, 150–154.CrossRefGoogle Scholar
Gur, R. C. & Sackeim, H. A. (1979). Self-deception: a concept in search of a phenomenon. Journal of Personality and Social Psychology 37, 147–169.CrossRefGoogle Scholar
Hughes, J. R., Casal, D. C. & Leon, A. S. (1986). Psychological effects of exercise: a randomized cross-over trial. Journal of Psychosomatic Research 30, 355–360.CrossRefGoogle ScholarPubMed
Hurst, J. W., Crawley, I. S., Morris, D. C. & Dorney, E. R. (1990). The history: symptoms and past events related to cardiovascular disease. In The Heart, 7th edn (ed. Hurst, J. W. et al. ), pp. 122–134. McGraw-Hill: New York.Google ScholarPubMed
Kamarck, T. & Jennings, J. R. (1991). Biobehavioral factors in sudden cardiac death. Psychological Bulletin 109, 42–75.CrossRefGoogle ScholarPubMed
Kennedy, G. J., Hofer, M. A., Cohen, D., Shindledecker, R. & Fisher, J. D. (1987). Significance of depression and cognitive impairment in patients undergoing programmed stimulation of cardiac arrhythmias. Psychosomatic Medicine 49, 410–421.CrossRefGoogle ScholarPubMed
King, A. C., Taylor, C. B., Haskell, W. L. & DeBusk, R. F. (1989). Influence of regular aerobic exercise on psychological health: a randomized, controlled trial of healthy middle-aged adults. Health Psychology 8, 305–324.CrossRefGoogle ScholarPubMed
Krantz, D. S. (1980). Cognitive processes and recovery from heart attack: a review and theoretical analysis. Journal of Human Stress 6, 27–38.CrossRefGoogle ScholarPubMed
Krantz, D. S., Helmers, K. F., Bairey, C. N., Nebel, L. E., Hedges, S. M. & Rozanski, A. (1991). Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease. Psychosomatic Medicine 53, 1–12.CrossRefGoogle ScholarPubMed
Ladwig, K. H., Kieser, M., König, J., Breithardt, G. & Borggrefe, M. (1991). Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study. European Heart Journal 12, 959–964.Google ScholarPubMed
Lane, R. D., Merikangas, K. R., Schwartz, G. E., Huang, S. S. & Prusoff, B. A. (1990). Inverse relationship between defensiveness and lifetime prevalence of psychiatric disorder. American Journal of Psychiatry 147, 573–578.Google ScholarPubMed
Litt, M. D. (1988). Cognitive mediators of stressful experience: self-efficacy and perceived control. Cognitive Therapy & Research 12, 241–260.CrossRefGoogle Scholar
McCrae, R. R. & Costa, P. T. (1983). Social desirability scales: more substance than style. Journal of Consulting and Clinical Psychology 51, 882–888.CrossRefGoogle Scholar
Mardia, K. V., Kent, J. T. & Bibby, J. M. (1979). Multivariate Analysis. Academic Press: London.Google Scholar
Markovitz, J. H. & Matthews, K. A. (1991). Platelets and coronary heart disease: potential psychophysiologic mechanisms. Psychosomatic Medicine 53, 643–668.CrossRefGoogle ScholarPubMed
Murphy, J. M., Monson, R. R., Olivier, D. C., Sobol, A. M. & Leighton, A. H. (1987). Affective disorder and mortality: a general population study. Archives of General Psychiatry 44, 473–480.CrossRefGoogle ScholarPubMed
O'Connor, G. T., Buring, J. E., Yusuf, S., Goldhaber, S. Z., Olmstead, E. M., Paffenbarger, R. S. & Hennekens, C. H. (1989). An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80, 234–244.CrossRefGoogle ScholarPubMed
Pancheri, P., Bellaterra, M., Matteoli, S., Cristofari, M., Polizzi, C. & Puletti, M. (1978). Infarct as a stress agent: life history and personality characteristics in improved versus not-improved patients after severe heart attack. Journal of Human Stress 4, 16–22.CrossRefGoogle ScholarPubMed
Ray, C. (1991). Chronic fatigue syndrome and depression: conceptual and methodological ambiguities. Psychological Medicine 21, 1–9.CrossRefGoogle ScholarPubMed
Ruberman, W., Weinblatt, E., Goldberg, J. D. & Chaudhary, B. S. (1984). Psychosocial influences on mortality after myocardial infarction. New England Journal of Medicine 311, 552–559CrossRefGoogle ScholarPubMed
Schleifer, S. J., Macari-Hinson, M. M., Coyle, D. A., Slater, W. R., Kahn, M., Gorlin, R. & Zucker, H. D. (1989). The nature and course of depression following myocardial infarction. Archives of Internal Medicine 149, 1785–1789.CrossRefGoogle ScholarPubMed
Shekelle, R. B., Vernon, S. W. & Ostfeld, A. M. (1991). Personality and coronary heart disease. Psychosomatic Medicine 53, 176–184.CrossRefGoogle ScholarPubMed
Silverstone, P. H. (1990). Depression increases mortality and morbidity in acute life-threatening medical illness. Journal of Psychosomatic Research 34, 651–657.CrossRefGoogle ScholarPubMed
Taylor, C. B., Houston-Miller, N., Ahn, D. K., Haskell, W. & DeBusk, R. F. (1986). The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients. Journal of Psychosomatic Research 30, 581–587.CrossRefGoogle ScholarPubMed
Van Der Ploeg, H. M., Defares, P. B. & Spielberger, C. D. (1980). ZBV. A Dutch-Language Adaptation of the Spielberger State-Trait Anxiety Inventory. Swets & Zeitlinger: Lisse, The Netherlands.Google Scholar
Wald, F. D. & Mellenbergh, G. J. (1990). The abbreviated version of the Dutch adaptation of the Profile of Mood States (POMS). Nederlands Tijdschrift voor de Psychologie 45, 86–90.Google Scholar
Watson, D. & Clark, L. A. (1992). Affects separable and inseparable: On the hierarchical arrangement of the negative affects. Journal of Personality and Social Psychology 62, 489–505.CrossRefGoogle Scholar
Watson, D. & Pennebaker, J. W. (1989). Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychological Review 96, 234–254.CrossRefGoogle ScholarPubMed
Watson, D. & Tellegen, A. (1985). Toward a consensual structure of mood. Psychological Bulletin 98, 219–235.CrossRefGoogle Scholar
Watson, D., Clark, L. A. & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology 54, 1063–1070.CrossRefGoogle ScholarPubMed
Wiklund, I., Sanne, H., Vedin, A. & Wilhelmsson, C. (1984). Psychosocial outcome one year after a first myocardial infarction. Journal of Psychosomatic Research 28, 309–321.CrossRefGoogle ScholarPubMed
Wiklund, I., Oden, A., Sanne, H., Ulvenstam, G., Wilhelmsson, C. & Wilhelmsen, L. (1988). Prognostic importance of somatic and psychosocial variables after a first myocardial infarction. American Journal of Epidemiology 128, 786–795.CrossRefGoogle ScholarPubMed
Zevon, M. A. & Tellegen, A. (1982). The structure of mood change: an ideographic/nomothetic analysis. Journal of Personality and Social Psychology 43, 111–122.CrossRefGoogle Scholar
Zuckerman, M. & Lubin, B. (1965). The Multiple Affect Adjective Check List. Educational and Industrial Testing Service: San Diego, CA.Google ScholarPubMed