SUMMARY 8 CONCLUSIONS

SUMMARY 8 CONCLUSIONS 9 Need for the study 9 Statement of the topic 9 Objectives of the study 9 Hypotheses 9 Methodology in brief 9 Sample for the study 9 Tools used for the study 9 Variables 9 Administration of tools 9 Consolidation of data 9 Statistical techniques used for analysis 9 Method of analysis 9 Findings 9 Conclusions 9 Suggestions for further research

Cardiovascular disorders continue to be one of the major causes of death in the world. Considerable progress has been achieved in reducing death due to infectious In contrast little progress has been made in the prevention or cure of cardiovascular disorders, largely because their etiology is poorly understood. There is an increasing evidence of the need to abandon the Uni-dimensional biological models of cardiovascular New advances in medicine and technology have improved the treatment of cardiovascular It came to the notice of eminent cardiologist that apart from the efficiency of treatment methods, some other factors complicate the prognosis. The mind-body and body-mind transition is continuous. The central nervous system serves as a bridge for the transition; and it links psychological factors to cardiac dysfunction. The interplay of biological and psychological factors in the development of cardiovascular disorders has long been suspected, but only recently has some scientific evidence begun supporting these suspicions. 5.1 Need for the study lnspite of all the advances in knowledge regarding the functioning of cardiovascular system and modern methods of prevention and treatment of cardiovascular disorders, it is still the major contributor of mortality and morbidity in lndia. In Kerala also mortality due to cardiovascular disease is highly significant, even though the socio economic and health parameters point to a better quality of life compared to other parts of India. Hence, in the present research, an analytical study is being made among the cardiovascular patients, non-cardiac patients and normals to trace out the differential influence of various psychosocial factors. 5.2 Statement of the topic "Psychological Correlates of Common Cardiovascular Disorders" 5.3 Major Objective of the study The main objective of the study was to find out the influence of psychological factors in cardiovascular

5.3.1 Specific objectives -177-1. To find out whether there exist any significant differences on the various sociodemographic variables among the three groups studied. 2. To find out whether there are any significant differences on the variable stress among the three groups and among the different cardiovascular 3. To find out whether there are any significant differences on the variable Type A behaviour among the three groups and among the different cardiovascular 4. To find out whether there are any significant differences on the variable personality among the three groups and among the different cardiovascular diseases 5. To find out whether there are any significant differences on the variable temperament among the three groups and among the different cardiovascular 6. To find out whether there are any significant differences on the variable self esteem among the three groups and among the different cardiovascular 7. To find out whether there are any significant differences on the state and trait dimensions of anger, anxiety and curiosity among the three groups and among the different cardiovascular 8. To find out whether there are any significant differences on the variable depression among the three groups and among the different cardiovascular - 5.4 Hypothesis 1. There will not be any significant difference between (a) malelfemale, (b) rurallurban, (c) lowlmediumlhigh socioeconomic status, (d) vegetarianlnon-vegetarian, (e) joint familylnuclear family (f) smoking- almost neverlsometimesloftenlalmost always and (g) alcohol consumption- almost never1 sometimes1 oftenlalmost always, on different cardiovascular disorders.

-178-2. There will be significant difference between cardiovascular disease patients and the two control groups (Normal and non-cardiac patients) on (I) family stress, (2) social stress, (3) personal stress, (4) occupational stress, (5) type A behaviour pattern, (6) introversion-extroversion, (7) neuroticism, (8) stable temperament, (9) objective temperament, (10) social temperament, (11) self-esteem, (12) state-anxiety, (13) state-curiosity, (14) state-anger, (15) trait-anxiety, (16) trait-curiosity, (17) trait-anger, and (1 8) depression. 3. There will be significant difference between different cardiovascular disease groups, viz., (I) Myocardial Infarction, (2) Angina, (3) Cardiac Surgery patients, (4) Essential Hypertension, (5) Arrhythmia, (6) Atherosclerosis, (7) Endocarditis and (8) Pericarditis, on the eighteen psychological variables. 5.5 Methodology in brief Exploratory research method, using structured interview schedules and standardized psychological inventories, was selected for the study. A pilot study was conducted on a representative sample of 50 cardiac patients from the different hospitals in Trivandrum. After the necessary modifications, the final study was carried out on a sample of 400 cardiac patients (representing 8 cardiovascular disease patient group of 50 each), 50 non-cardiac patients and 50 normal sample. The data thus collected were analyzed using appropriate statistical techniques. 5.6 Sample for the study Three categories of respondents were selected for the present study. The first category comprises different cardiovascular disease patients. This includes 8 different cardiovascular disease patients, viz., Myocardial Infarction (MI), Angina (AN), Cardiac Surgery (CS), Essential Hypertension (EH), Arrhythmia (ARR), Atherosclerosis (ATH), Endocarditis (EN) and Pericarditis (PE). 50 patients each (total of 400) was selected on the basis of the diagnosis of expert cardiologist, constitute the cardiovascular disease patient group. The second category comprised of 50 non-cardiac patients, and the third

-179- group with a sample size of 50 representing the normal group. Purposive sampling technique was followed for the selection of samples. The samples were identified from the major hospitals in the state of Kerala. 5.7 Tools used for the study The following tools were used for collecting the data required for the study. 1. Personal Data Schedule 2. Stress lnventory 3. Type A Ekhaviour lnventory 4. Depression lnventory 5. State-trait Personality lnventory 6. Eysenck Personality lnventory 7. Generalized T Scale, and 8. Self-esteem Inventory. Of the seven tools, four, viz., Stress Inventory, Type A Ekhaviour Inventory, Depression Inventory, State-trait Personality Inventory, including a personal data schedule, were developed by the investigator for the present study. ltem analyses for the said tools were done using the Mathew ltem analysis table. Test retest reliability and concurrent validity have also been established for the said tools. 5.8 Variables In the present study seven standardized inventories and one unstructured personal data schedule have been used. Altogether eighteen emotional variables are studied. The variables are 1 Family Stress 2 Social Stress 3 Personal Stress 4 Occupational stress 5 Type A Ekhaviour Pattern 6 Introversion-Extroversion 7 Neuroticism 8 Stable Temperament

9 Objective Temperament 11 Self-esteem 13 Trait Anxiety 15 Trait Curiosity 17 Trait Anger, and 10. Sociable Temperament 12 State Anxiety 14 State Curiosity 16 State Anger 18 Depression -180-5.9 Administration The data for the present study were collected from patients in different hospitals in the state of Kerala. Categorisation of the 8 groups of cardiovascular disease patients was made with the help of the diagnosis made by the concerned medical practitioners. The detailed information regarding the medical aspects of the patients was collected from the case records provided from the hospitals. The researcher met each patient individually to collect the required information. Due to - the peculiar nature of the illness, personal visits were possible only after a week from their date of admission in the hospitals. Because of the serious nature of the patients, all the interviews were conducted at the hospital ward I room itself. It took about 30 minutes to complete a set of inventories, but sufficient time was given to the subjects depending upon the health conditions of the patient. The inventories were read out to those patients who were either illiterate or were not able to comprehend the items properly, to secure correct and appropriate information. 5.10 Consolidation of Data The relevant data obtained from the subjects using the personal data schedule and the 7 set of inventories were consolidated in a coding sheet, in the following way: each subject was given an identification number and against that number the data relating to personal information like age, sex, religion etc and the scores obtained for different variables were entered in a single line. The data thus consolidated are subjected to statistical analysis.

5.1 1 Statistical Techniques Used for Analysis -181- Computer facilities were used for analysing the data. The main statistical techniques used for analysis were: Chi-square, Multivariate Analysis of Variance (MANOVA), Univariate Analysis of Variance (ANOVA), Scheffe Procedure and Discriminant Function Analysis. 5.12 Method of Analysis The present study is tried to find out the psychosocial correlates of cardiovascular For this, a set of tools comprising of 18 psychosocial variables and 10 groups of subjects (8 cardiovascular disease patients, 1 non-cardiac patient group, and 1 normal group) were included. To make the study more fruitful and effective two type of group comparison has been made. As a first criterion, the total sample (500) has been divided in to three groups (Three group classifications) viz., cardiovascular patient group (400), non-cardiac patient group (50) and normal group (50). lnorder to get a clear picture about the different cardiovascular diseases, a second criterion was used. For this, the cardiovascular disease patients (400) were divided into eight different groups (50 each) based on the diagnosis of the concerned medical practitioners. They are, Myocardial Infarction (MI), Angina (AN), Essential Hypertension (EH), Cardiac Surgery (CS), Atherosclerosis (ATH), Arrhythmia (ARR), Endocarditis (EN), and Pericarditis (PE). The other two groups are Normal (NS) and Non-Cardiac Patients (NCP). As a preliminary step, Chi-square analysis has been attempted using selected sociodemographic variables based on the ten-group classification. Manova, Anova and Scheffe's procedure were computed with the three and ten group classification. The Discriminant analysis was also done for the two type of classifications. Finally graphs were also plotted based on the mean values of different variables based on the disease categories.

-182-5.13 Findings The need for understanding and studying the presence of psychosocial correlates forthe correct diagnosis and effective treatment of cardiac diseases has been emphasized by this study. 5.13.1 Findings - Psychological Variables. 1. Family stress may cause cardiovascular 2. Social stress does not lead to cardiovascular 3. Personal stress may cause cardiovascular Individuals who experience high occupational stress are prone to cardiovascular Cardiac patients are generally extroverts. High extroversion can lead to cardiac Persons with high neuroticism may end as cardiac patients. Cardiac patients show neurotic tendencies. Cardiac patients show less stable temperament than the normals. Cardiac patients are of less objective-temperament than normal, but higher than non-cardiac patients on stabile-temperament. Cardiac patients lack objectivity. Sociability is not a scale to diagnose or predict cardiac disease conditions. Cardiac patients have less self-esteem due to the constant awareness of physical constraints and fear of unpredictable situations. Cardiac patients are people prone to state anxiety and score high on state anxiety. Cardiac patients have trait anxiety due to their physiological conditions.

14. Cardiac patients are generally curious. They score high on state curiosity. -183-15. The fear of impending death changes the attitude of cardiac patients. They develop trait curiosity because they feel that they should learn and understand novel things in a short period. 16. Cardiac patients as a whole have high score than normal for state anger. But cardiac surgery groups differ in that they have low score. 17. Same as in state anger, cardiac patients except cardiac surgery gmup score high on trait anger. 18. Cardiac patients as a whole are susceptible to depression. 5.13.2 Findings - Demographic Variables. Age is an important variable that leads to cardiac Religion and specific lifestyles are related to cardiac Place of residence determines the type of cardiac disease a patient may contract. Type of family determines the proportion of incidence of cardiovascular Size of family is another variable, which leads to cardiovascular Food habit is highly significant in causing cardiovascular Smoking has a profound influence on the occurrence of cardiovascular Alcoholism influences occurrence of cardiovascular A history of blood pressureldiabeficslotherdiseases makes an individual pmne to cardiovascular Early history of hospitalisation due to cardiac diseases is another clue for predicting the chances of cardiac Sex has no influence on cardiovascular Socio-economic status does not influence presence or absence of cardiovascular

5.14 Conclusions -184-1. The importance of understanding the psychosocial correlates of cardiovascular diseases has been undoubtedly established. 2. The influence of demographic variables on causing or aggravating cardiovascular diseases has been proved. 3. Discriminant analysis of selected case studies has led to the identification of predictors for each cardiac subgroup, which will help in the effective prevention or treatment of cardiovascular 4. 70% accuracy for predicting cardiac disease groups in general could be obtained by the discriminate analysis. 5. The interplay of physical and psychological factors in the development of cardiovascular diseases is a truth and not a myth. 5.15 Suggestions for further research i. It would be ideal ir separate studies are conducted in each of the cardiac disorder group and compare it with normals and non-cardiac patients. ii. Higher sample size in each group may be attempted to strengthen the already established results. iii. Based on the findings of discriminant analysis, i.e., the predictor variables, a profile can be developed. An exploratory study with 5 or 10 years follow up can be conducted to specify the incidence or occurrence of cardiac disorders. iv. Since the present findings strongly support the impact of psychological variables, a package programme for the management of psychological problems can be developed. v. The package can be tested during the rehabilitation phase and thereby assess the efficacy of such programmes.