Psychological factors related to delay in seeking treatment for symptoms of acute myocardial infarction

• Main Author: Kenyon, Lori White
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-1990
• Subjects: Clinical psychology; Medicine; Psychotherapy; Surgery
• ISBN: 9798207522579

Prior studies have been able to explain only a small amount of the variance in prehospital delay during acute myocardial infarction (AMI), and few have examined psychological factors related to this delay. The present study assessed the relationship of demographic, medical history, and psychological variables with prehospital delay (time from onset of symptoms to arrival in hospital) in 103 patients with confirmed AMI. Subjects, AMI patients admitted to Henry Ford Hospital, Detroit, Michigan between October, 1989 and January, 1990, were interviewed in the hospital, usually within 3 to 6 days of admittance. The interview included questions on prehospital symptom experience, demographics, and medical history, as well as measures of somatic awareness (MSPQ), alexithymia (TAS, KSSFC), and Type A behavior (FTAS). Multiple regression analysis of 11 variables identified 3 predictors (whether patients believed they were having an AMI, medical index of severity of AMI--peak CPK--and MSPQ score) which accounted for a significant 17% of the variability in total delay time. If patients believed they were experiencing a heart attack, if the AMI was relatively severe, and/or if they had relatively high levels of somatic awareness, they tended to evidence less delay in seeking medical treatment than patients without these qualities. These results suggest that MSPQ score is the only variable which can be determined prior to evolution of an AMI which was significantly related to delay. While subjects with low somatic awareness delayed a median of 7 hours prior to seeking treatment, the group with high somatic sensitivity delayed a median of 4 hours (groups created by cutting at the median of the MSPQ). This finding has great clinical significance because of the importance of administering thrombolytic medications within 4 to 6 hours of symptom onset in order to substantially reduce mortality and enhance outcome. Therefore, assessment of levels of somatic awareness may be valuable in prior identification of patients at risk of extensive prehospital delay during AMI.