Emotion Profiles and Quality-of-Life of Paced Patients

Emotion Profiles and Quality-of-Lifeof Paced Patients

KATIJA CATIPOVIC-VESELICA, SANDA SKRINJARIC.SLOBODAN MRDENOVIC, NIHADA MUJIC, BRANIMIR CATIPOVIC,MiRTA ANDRIC, IRENA VIZNER-LOVRIC, and ANTE LAUC

From the General Hospital Osijek, Internal Clinic. Psychiatric Clinic.Study of Medicine, Osijek. Yugoslavia

CATIPOVIC-VESELICA, K., ET AL.: Emotion Profiles and Quality-of-Life of Paced Patients. More thanany other organ of human anatomy, (he heart is symbolically charged wi(h emotions. Introducing a foreignbody info (he heart, even a pacemaker, would be expected to alter, if not damage the most intimate 0/personal attributes, an individual's personality. Nevertheless, standard measures 0/emotions, adminis-tered be/ore and after pacemaker implantation, revealed an improvement in psychological ivell-being inan unselected sample of 80 patients, aged 36 to BO years. Furthermore, these results occurred whether or notpatier\ts returned to work. {PACE. Vol. 13, April 1990}

emotion, quality-of-life, pacing

Introduction

In 1986, data from 26 countries were col-lected from 234.554 patients with pacemakersimplanted in nearly 5,500 hospitals.^ The mostfrequent clinical indications for pacing were syn-cope, dizzy spells, and bradycardia, respec-tively.^"^ In most cases, programmable pace-makers vjeve implanted and transvenous lead in-sertion was preferred by the majority ofimplanters. The most popular mode of pacing wassingle chamber VVl.̂

With the progress in the field of pacing in thelast 30 years, awareness has grown regarding theeffects of psychological factors involved duringtreatment. Our study evaluates the long-term im-pact of emotional, psychological, and life-stylevariables on an individual's personality afterpacemaker implant.

Address for reprints; Katija Catipovic-Veselica, 54000 Osijek,Vukovarska 144. Yugoslavia.

Received April 26, 1989; Revision [uly 25, 1989; Revision De-cember 15, 1989; Accepted December 22, 1989.

Patients and Methods

Eighty patients with permanent VVI pace-makers were studied for 1 to 4 years; the studyincluded 43 men aged 36-83 years, and 37 womenaged 40-82 years. The clinical and medical datacollected included: age, sex, employability. socio-economic status, marital status, and severity oftheir disease according to the NYHA functionalclassifications (Table 1). Patients were inter-viewed and were required to assess their per-ceived quality-of-Iife using the Emotions ProfileIndex (EPI), The EPl. designed by Plutchik, mea-sures the strengths of eight basic emotions.^

The EPl is a 62-item forced-choice test. It iscomposed of 12 trait terms that are paired in allpossible combinations. The person taking the testis asked to indicate which of the two paired wordsis more descriptive of him or herself; for example,is he more shy or more gloomy? The choices arescored in terms of the emotions implied by thetrait word; for example, shyness implies fear,while gloominess implies sadness, etc.

In this manner, scores on the eight basicemotion dimensions are obtained. In addition,

PACE. Vol. 13 April 1990 399

CATIPOVIC-VESELICA, ET AL.

SubjectsCharacteristics

MenWomen

YesNo

LowMediumHigh

MarriedWidowWidower

1tlIIIIVHeart FailureAngina pectoris

Descriptive

31-40

11

1*1

200

200

020000

Table 1.

Characteristics of 80 Individuals VVI Pacemakers

Age Range

41-50 51-60Number of

50

32

45

Employability

0g

Socioeconomic status

140

500

270

Marital status

810

NYHA functional class

041000

090000

61-70Patients

1015

025

5200

1852

023

1111

71-80

1711

028

9190

12132

0197251

81-90

65

011

551

344

083020

there is a bias score that reflects the tendency ofthe individual to choose socially desirable alter-natives. The raw scores for each emotion dimen-sion were tabulated in a cumulated frequencydistribution and percentile equivalents were ob-tained for each emotion dimension. As a roughguide to interpretation, percentiie scores over the60th percentile may be considered "high", whilethose below the 40th percentile may be consid-ered "low".

Below are brief descriptions of each emotionused in the system::

1. Protection. A tendency to withdraw, feel-ings of pain, timidity, fear, shame, etc.

2. Destruction. A tendency to attack and de-stroy, feelings of anger and hostility.

3. Rejection. A tendency to reject people oravoid new experiences, feelings of boredom, dis-like, and disgust.

4. Incorporation. A tendency to accept peo-ple, receiving of gifts, feelings of acquiescence orgreed.

5. Deprivation. Feelings of loss, sorrow,apathy, disappointment, and loneliness.

6. Reproduction. A tendency to desire sexualor warm contact with a specific person, feelings ofhappiness, sympathy, relief.

7. Exploration. A tendency to desire new ex-periences, feelings of expectancy, fascination, etc.

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EMOTION PROFILES AND QUALITY-OF-UFE

Table II.

Dimensions in Polarity for 80 Individuals with VVI Pacers before and after Impiantationon a Scale from 1 to 5

Dimensions inPolarity

Weak-strong"

Slow-quick

Passive-active*

Tired-enduring"

Unhappy-happy

Sad-gay

Ill-healthy

1

2430101245

15192656

1215

Before

2

1417151914172531263313161519

Number and

Implantation Marks

3

2329293629362126243028353240

4

1417202529361316192419241519

Percentile

5

5667456756

1819

CT

)

7

1

567

CT

)

45

1316

2279

1620

of Patients

After Implantation

2

23291924

56

1215131623292227

3

4354425225311519324023292835

Marks

4

799

11

33412329182322271316

5

2234

1316172114

185611

Statistical significant polarity

8. Orientation. Feeling surprise, wonder,confusion in relation to unexpected objects or ex-periences.

Before and after implantation, patients alsoestimated seven dimensions of emotional polarityon a scale from 1 to 5 (Table II). The dimensionsare: weak-strong, slow-quick, passive-active,tired-enduring, unhappy-happy, sad-gay, and ill-healthy.

EPI is a usefnl test instrument currentlybeing used in a number of studies.^"'"

Results

Emotion Intensity

The mean percentile scores for the patientsemotion dimensions are compared to a mean sam-ple presented in Table III, Emotion dimension in-tensities for reproduction, protection, and incor-poration were high (over the 60th percentile) andintensities for rejection and destruction were low(below the 40th percentile). Other emotions werea normal percent of the scores. The emotion di-

mension reproduction showed low intensities insix patients (7.5%), incorporation was displayedin five (6.2%), deprivation in 21 (26.2%), orienta-tion in 21 (26.2%), exploration in 18 (22.5%). andprotection in 7 patients (8.7%). The emotion di-

Table III.

Comparison of Mean Percentile Scores Using theEmotions Profile Index for 80 Individuals with VVIPacers and for 708 Normal Males and Females

Mean Percentile Scores

Emotion Scales

IncorporationReproductionDestructionExplorationRejectionDeprivationProtectionOrientation

Paced Patients

6968354825506256

5 + 18.49 ± 19.9.2 ± 16

± 16± 19± 20± 17± 14

Norm Group

78753545

24406440

PACE. Vol. 13 April 1990 401

CATIPOVIC-VESELICA, ET AL.

mension deprivation had high intensities in 25patients (30.2%).

We observed that 59 patients (73.7%) lead anormal life for their age, 13 patients (16.2%) leadhetter, and 8 patients (10%) lead worse lives fortheir age, 54 patients (67.5%) are as mentally ca-pable as people their age. 4 (5%) are able andclever, and 22 (27.5%) are not as able as others, 38(47.5%) think their health is worse than others, 26(32.5%) think their health is the same, and 16(20%) think that their health is better than thehealth of their friends, 54 (67.5%) patients an-swered that they tire quickly, 20 (25%) tire some-times, and 6 (7.5%) do not tire, 46 (57%) patientsanswered they are very happy. 34 (42.5%) are not,and 54 (67.5%) report they are not able to work.

Guize et al." found that: 92% of patients re-ported to be happy, 87% lead a normal life fortheir age, and 70.5% reported reducing their ac-tivity.

Although the majority of subjects (81%) werein NYHA functional Class II. free of health wor-ries, lead normal lives, and saw themselves just ascapable and clever as their peers. Two-thirds ofthe patients had no motivation for working be-cause the salary remains the same for workersand nonworkers in Yugoslavia.

Emotional Polarity

Results were obtained using the x̂ test andStudent's t-test. and the polarity dimensions be-fore and after implantation are sbown in Tahle ILThere are statistically significant differences be-fore and after implantation in the following polar-ity dimensions: weak-strong (x^ ^ 24.3, P< 0.001); passive-active (x^ - 9.58, P < 0.05);tired-enduring (x̂ = 13.7, P < 0.01); unhappy-happy (x̂ - 11.05, P < 0.05). There were no sta-tistically significant differences before and afterimplantation in the remaining polarity dimen-sions: slow-quick (x^ 8.55, P > 0.05), sad-gay (x̂8.8. P > 0.5). ill-healthy (x̂ 5.8. P > 0.05). Figure 1is a graphic display of statistically significant di-mensions in polarity before and after implanta-tion.

We compared the mean percentile score fromthe EPI of 80 paced patients with the same scoresfrom 708 unselected Yugoslavian people.^^ Com-paring the paced and unpaced patients showed nostatistically significant differences in six emotion

dimensions (incorporation, reproduction, de-struction, exploration, rejection, and protection)(P > 0.05). However, paced patients are more de-privated and more orientated. The statistical dif-ferences were: t = 4.5, P < 0.01; t = 10.6, P < 0.01.

In polarity dimensions there is statistical sig-nificant displacement on an average of strength,happiness, activity, and endurance after implan-tation.

Discussion

Recently, other investigators have studiedthe role of psychosocial factors in the rehabilita-tion of patients who have undergone cardiac sur-gery. Despite organic improvement, slow and dif-ficult adjustment, and the persistence or worsen-ing of untoward psychological conditions havebeen observed in 25% to 40% of patients.^^"'^Magni et al.̂ ^ found significant psychological dis-turbances in 25% to 40% of patients who under-went cardiac surgery. In as many as one-fourth ofpatients, surgical treatment improved physicalcondition, however, it did not necessarily pro-duce an analogous improvement in the patient'spsychological well-being.

Our paced patients, as compared to the nor-mal group, were found to be spontaneous,friendly, curious, satisfied, and intellectuallycompetent. (Johnson et al.'^ found improvedmental function with pacemaker treatment.) Pa-tients had a low intensity of destruction and thuswere easy going and unaggressive. There was alsoa low intensity of rejection, thus patients tendedto be uncritical, unrejecting, and unwasteful.Orientation and exploration dimensions werenormal.

Conclusion

Using the EPI, positive emotions dominateafter pacemaker implantation. The quality-of-lifeof paced patients is satisfying and better after im-plantation. We conclude that routine care by thesurgical team should be sufficient in most casesfor patients to experience a favorable postopera-tive psychological adjustment. Those who do notexperience a significant elevation in mood andsense of adequacy following surgery may needfurther medical investigation for occult illness orreferral to a mental health specialist.

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EMOTION PROFILES AND QUALITY-OF-LIFE

% ^

yi

ztU

Q

J(̂

Ul

uQt

9o

4c -

^ ..

* • • •

io ••

I I 1 I - * •

I t

Figure 1. Graphic display of dimensions in polarity (ha! are signijicanlJy different after ini-pJantation. A = weak-strong; B = passive-active; C = tired-enduring; D = unhappy-happy;be/ore implantation; after impiantafion.

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CATIPOVIC-VESELICA. ET AL.

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