Commentary on Son H, Thomas SA and Friedmann E (2012) The association between psychological distress and coping patterns in post-MI patients and their partners. Journal of Clinical Nursing 21, 2392–2394


  • Geraldine Lee PhD, PGDE, BSc

    Lecturer, Corresponding author
    1. Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK
    • Correspondence: Geraldine Lee, Lecturer, Florence Nightingale School of Nursing & Midwifery, King's College London, 57 Waterloo Road, London SE1 8WA, UK. Telephone: +44 (0) 207 848 3201.


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The physiological effects of depression and in particular increases in inflammatory markers are now well established. Depression is now categorised as a risk factor in the development of coronary heart disease (CHD). It is not surprising that postmyocardial infarction (post-MI), patients and spouses experience depression, anxiety, distress and problems coping. Son et al. (2012) in their research-in-brief examined the association between psychological distress and coping patterns post-MI and are to be commended for inclusion of spouses. The spouse is often overlooked and importantly, men often over-report their health and under-report their psychological distress as compared to their spouse (Lee 2008). There is no doubt that differences in coping and perceptions exist between men and women, and it would be interesting if the authors had female patients and could report results on male and female patients and their respective spouses.

The use of the Spielberger Inventory and Beck Inventory to measure anxiety and depression, respectively, are suitable tools. Anxiety and depression have previously been identified as major determinants in quality of life before and after cardiac surgery (Ballan & Lee 2007, Lee 2009). As well as anxiety and depression, recent research has implicated personality type D as a factor in CHD (with the D standing for distress). Individuals with type D personality tend to be negative in their emotional responses and incidence of between 18–53% in cardiac patients has been reported. It may be that Type D has an important role in coping post-MI. Given that Son et al. (2012) observed anxiety in 21% and depression in 20% of patients at baseline, examining personality type would have been interesting in these individuals.

The patient cohort examined were male and predominantly Caucasian, so it is unknown if the same levels of psychological distress exist in other ethnicities and females. The authors highlight the importance in identifying distressed patients and recently it has been proposed that nurses should screen all cardiac admissions for depression. There is no doubt that post-MI, some patients and their spouses will exhibit poor coping strategies and to date, vulnerability in acute care patients is poorly understood (Scanlon & Lee 2007). Son et al. (2012) study adds further information on this complex topic and in drawing nurses' attention to psychological distress in MI patients.