Étude des caractéristiques psychologiques des patients coronariens en situation de gestion du stress et leurs conséquences.

La tolérance au stress a été évaluée auprès de 58 patients souffrant de maladies cardiovasculaires à l’aide du « test de frustration » de Rosenzweig. Ces mesures ont été complétées par une évaluation de la qualité de vie, du coping, de l’anxiété, de la dépression, du sentiment d’efficacité perçue ainsi que de l’affectivité négative et de l’inhibition sociale.

Les comparaisons de moyennes montrent que par rapport à la population de référence, les patients coronariens face à la frustration ont significativement plus tendance à se culpabiliser ou à nier la responsabilité d’une personne ainsi qu’à inhiber leur agressivité. De plus, ils répriment davantage leurs émotions et s’orientent vers la recherche de solution.

On peut supposer que cette répression émotionnelle est efficace à court terme sur la qualité de vie dans la mesure où elle permet de mettre à distance le choc lié à l’infarctus du myocarde. Mais on peut s’interroger sur les conséquences du maintien de cette répression à long terme sur la qualité de vie des patients et leur état de santé futur.

The aim of the present study is to investigate psychological characteristics of frustration management and their consequences in coronary patients.

A sample of N=58 myocardial infarction patients completed questionnaires measuring self-efficacy (Schwarzer), negative affectivity and social inhibition (type D, Denollet), coping strategies (Coping Questionnaire for Coronary Patients [CQCP], Maës); Anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Zigmond and Snaith), quality of life after myocardial infarction (MacNew Heart Disease Health-related Quality of Life Questionnaire, Hillers) and frustration management (Picture Frustration Study [PFS], Rosenzweig).

The results show that frustration management in coronary patients differs significantly from that of the reference population. During frustration management the coronary patients present comparatively higher levels of culpability (high I answers) or denial of the responsibility of others (high M answers), as well as lower levels of aggressiveness (low E answers) than the reference population. Furthermore, myocardial infarction patients tend to rather repress their feelings (few ED answers) and to look for active solutions (high NP answers) (Table 1). Patients with a high self-efficacy score look significantly more for active solutions in their frustration management (NP) (r=0.27), whereas patients with negative affectivity and social inhibition look for fewer solutions (respectively r=–0.31, r=–0.26). The social inhibition is significantly associated with answers of “Obstacle Dominance” (OD) (r=0.28). Within the four coping strategies studied, only the focusing on the problem resolution one is significantly linked to the frustration management responses. Patients using a problem-focused strategy show lower levels of “Ego Defence” for frustration management (r=–0.31) and higher levels of “Need-Persistence” (NP) (r=0.31). Furthermore, results show that “Ego Defence” (ED) is positively related to anxiety (r=0.27), whereas “Need persistence” (NP) is negatively linked to anxiety (r=–0.28) and negatively to depressive affects (r=–0.29). Patients indicating more extrapunitive answers (E) report significantly lower levels of quality of life (r=–0.29), whereas non-punitive answers (M) are associated with higher degrees of quality of life (r=0.31). No other significant associations were found between frustration answers and quality of life.

Emotional repression may be a short-term efficient strategy for the patients, allowing a distancing from the myocardial infarction trauma and increasing the quality of life. In the long-term, however, high levels of emotional repression could have negative effects on the global quality of life and the health of the patients.