Coping with coronary heart disease: a longitudinal study.

This longitudinal study evaluated the effects of two types of coping strategies, approach and avoidance, on anxiety, depression, and well-being in patients with coronary heart disease. Measurements were made at three timepoints: 1 month, 3 months, and 12 months after the cardiac event. Both cross-sectional and longitudinal relations were explored. At all three measurement points significant negative cross-sectional relations were found between approach and well-being, and significant positive cross-sectional relations were found between approach, on the one hand, and anxiety and depression, on the other. At the first measurement point, avoidance showed a positive association with well-being, and a negative association with anxiety. Longitudinal analyses, however, revealed a negative relationship between approach at the first measurement points and anxiety and depression at later measurement points. Likewise, there was a positive association between approach at the first two measurement points and well-being at later measurement points. The results of this study demonstrate the importance of facing and working through the trauma of the coronary event. Although unfavorable in the short term, working through the trauma can attenuate long-term emotional distress. These results suggest that assessment of the psychological consequences of coronary heart disease and development of interventions should not be based only on cross-sectional data, but should take into account longitudinal relations between coping and psychosocial outcome measures.