Assessing mental health outcomes in a rural cardiac rehabilitation program
Thomas Joseph Doherty (2002)
This study assessed mental health outcomes for a 2-year sample of medical patients ( n = 131) who attended a cardiac rehabilitation (CR) program at a rural community hospital in Southern New Hampshire. Psychological symptoms and health-related quality of life were assessed using standardized self-report measures and results were analyzed for clinically significant change. The study also assessed patients' level of socially desirable responding to provide information on the validity of self-report questionnaires with this population. CR patients reported significant decreases in psychological distress ( p = .003) and significant improvements in physical and mental health-related quality of life ( p < .001) after program attendance. Patients' functional status was assessed using norm data for each outcome measure. For example, 75.6% of patients reported physical health-related quality of life in a norm range associated with a recent myocardial infarction at intake, and 36% endorsed clinically significant changes at program completion and recovered to the level of age norms. CR patients were significantly higher in social desirability than a norm sample ( p < .0005). High social desirability was significantly associated with less reporting of psychological distress ( r = -.506, p = .005) and better reports of mental-health related quality of life ( r = .363, p = .005) but was not associated with physical-health related quality of life ( r = .023, p = .837). That is, patients in this sample appeared more likely to endorse physical impairments than psychological impairments. Mental health outcomes were not significantly different for CR attendees who responded to a follow-up survey ( n = 51). A group of patients who were referred, but did not attend the CR program (NCR, n = 10), also completed follow-up. Barriers to attendance for the NCR group were assessed using a questionnaire designed for this study. Results were discussed in the context of current research about the psychological aspects of heart disease, challenges in the psychological assessment of medical patients, and local New England cultural factors. Directions for future research and implications for clinical practice at this site were provided.