Spiritual coping of Maltese patients with first acute myocardial infarction: a longitudinal study
Research provides evidence about the high levels of anxiety and depression in myocardial infarction (MI). This is because patients with MI face both an acute life-threatening illness and the potential for living with a major illness (Roebuck et al. 2001, Thornton 2001, Kim et al. 2000). Consequently, the patients' whole sense of meaning and purpose in life is at stake (Walton 1999, Burnard 1987, Simsen 1985). Research on spiritual coping and spiritual well being (SWB) in MI is still in its infancy. Therefore the aim of the study was to identify possible relationships between spiritual coping strategies (SCS) and anxiety, depression, SWB and personal characteristics of Maltese patients with MI, during hospitalisation and the first three months after discharge.The longitudinal descriptive correlational study recruited a homogenous systematic sample of seventy male (n=46) and female (n=24) patients with first MI, mean age of 61.9 years. The variables under investigation were assessed by the translated versions of the Hospital Anxiety and Depression (HAD) scale (Zigmond and Snaith 1983), JAREL------ SWB scale (Hungelmann et al.1985) and Helpfulness of Spiritual Coping Strategies (HSCS) scale designed for the study. The rationale for the perceived helpfulness of SCS was explored by the semi-structured face to face interview.The theoretical framework which guided the study incorporated the Cognitive Theory of Stress and Coping (Lazarus and Folkman 1984) and the Idea of the Holy (Otto 1950). Analysis of the qualitative data was guided by Burnard (1991) analysis model. Additionally, analysis of the quantitative data utilized both parametric and nonparametric statistical tests in order to identify differences between means of subgroups of the personal characteristics and correlations between SCS and anxiety, depression and SWB across time.The findings revealed a constant decline of anxiety and depression across time which is inconsistent with published research. However, the return of anxiety and depression to normal limits by the third month is congruent with research. In contrast, scores of SWB and SCS increased on discharge and remained stable across time.The qualitative data revealed that SCS, SWB and the Maltese culture, which promotes family support in illness, may have contributed towards the relief of anxiety and depression. The quantitative data exhibited a negative, significant relationship between SCS and anxiety and depression on the sixth week after discharge. Additionally, positive significant relationships were identified between SCS and SWB across time.The findings suggest that SWB may be a precursor to the relief of anxiety and depression. The minimal significant differences in SCS between the subgroups of personal characteristics propose the possible impact of the event of MI on spiritual coping and negative mood states. However these speculations may only be confirmed by further research as recommended in the study. Hopefully, the new knowledge produced by the study will be applied to the clinical practice and nursing education to promote patient care.