Psychological and psychosomatic profile of depressed patients with acute coronary syndromes who do not accept psychological help.

Introduction: Several studies focused on the treatment of depression in patients with Acute Coronary Syndromes (ACS). However, there is less evidence on the recruitment phase, mostly related to patients’ medical characteristics. The aim of this preliminary research is to investigate socio-demographic, psychosomatic (demoralization, type A behavior) and psychological variables related to the refusal to receive psychological support (either cognitive-behavioral therapy or clinical management) and further cardiac monitoring, provided by TREATED-ACS study. Methods: 62 patients who suffered from a first episode of ACS and a depressive state based on DSM (major/minor depression or dysthymia) or DCPR (demoralization), were included into two groups on the basis of the agreement (N=46) or the refusal (N=16) to receive psychological support. The psychological assessment involved both self- (Symptom Questionnaire, Psychological Well-Being scales) and observer-rated (DSM-IV and DCPR structured interviews and Clinical Interview for Depression) instruments. Results: 42.5% of the interviewed patients suffered from depression. Compared to the enrolled patients, those who did not agree to participate suffered more frequently from dysthymia, showed significantly higher levels of hostility (SQ) and higher scores of autonomy (PWB). Discussion/conclusion: Since dysthymia is not characterized by an acute event that might encourage to seek and/or to accept psychological help, it could be related to the refusal of psychological support, as in the case of hostility. Moreover, the tendency towards autonomy could, on one hand, boost the effective management of the disease and, on the other hand, expose patients to imprudent behaviors. Further studies are needed to evaluate the course of cardiac disease in patients with those psychological characteristics.