Objective: Distress and low perceived social support were examined as indicators of psychosocial vulnerability in patients about to undergo heart surgery. Design: A total of 550 study patients underwent heart surgeries, including bypass grafting and valve procedures. Psychosocial interviews were conducted about five days before surgery, and biomedical data were obtained from hospital records. Main Outcome Measures: Sociodemographic, personality, religious, and biomedical factors were evaluated as predictors of psychosocial vulnerability, and all five sets of variables were evaluated as contributors to hospital length of stay (LOS). Results: Patients scoring higher on one or more indicator of presurgical psychosocial vulnerability were younger, more likely to be female, less likely to be married, less well educated, lower in dispositional optimism, higher in trait anger, and lower in religiousness. Older age, depression, low support, and low trait anger each showed an independent, prospective association with greater LOS, and several other predictors had prospective relationships with LOS that were statistically mediated by depression or perceived support. Conclusion: Evidence that multiple psychosocial factors may influence adaptation to heart surgery has implications for understanding and ameliorating presurgical distress and for improving postsurgical recovery.

Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways.Measurement of religion, religiousness, and spirituality for the purposes of health research has been an evolving enterprise. Beginning with Durkheim's Suicide (1897/1951, and continuing through the 1960s and 1970s, epidemiological studies focused on mortality or health differences among religious affiliations. Studies of suicide, cardiovascular disease, and cancer deaths were based on comparisons of mortality rates of mainstream and sectarian religious groups such as Seventh Day Adventists, Mormons, and the Amish, which were often lower than those of other religious groups or standard populations (Jarvis & Northcott, 1987). Religion was treated as a characteristic of groups, not individuals. The dependent variables were rates (all-cause, or cause-specific mortality), and the mechanisms of effect remained NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript speculative, or focused specifically on health-risk-related practices, including vegetarian diet and prohibitions against smoking or alcohol.A second wave of studies beginning in 1979 took an entirely different approach. These studies treated religiousness as a characteristic of individuals, and conceptualized it as one type of social tie making up an individual's social network, along with families, friendships, and voluntary and community group memberships (House, Landis, & Umberson, 1988). In these studies religiousness was measured with a single item asking about attendance at services or membership in a congregation; the individual's specific religious affiliation, the basis for all of the previous research, was now usually absent. Reviews during this period of research consistently criticized the unidimensional, typically single-item operationalization of religiousness, and pointed out that lack of development in measurement of the key concept was a major barrier to progress in the field (e.g. Levin, 1994).Since then, research on religion and health has maintained a focus at the individual level of analysis. Innovations in measurement largely h...

Marriage has long been linked to lower risk for adult mortality in population and clinical studies. In a regional sample of patients (n = 569) undergoing cardiac surgery, we compared 5-year hazards of mortality for married persons with those of widowed, separated or divorced, and never married persons using data from medical records and psychosocial interviews. After adjusting for demographics and pre- and postsurgical health, unmarried persons had 1.90 times the hazard of mortality of married persons; the disaggregated widowed, never married, and divorced or separated groups had similar hazards, as did men and women. The adjusted hazard for immediate postsurgical mortality was 3.33; the adjusted hazard for long-term mortality was 1.71, and this was mediated by married persons' lower smoking rates. The findings underscore the role of spouses (both male and female) in caregiving during health crises and the social control of health behaviors.

Objective: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. Methods: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. Results: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. Conclusions: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery. Key words: Center for Epidemiologic Studies Depression Scale, depressive symptoms, coronary artery bypass graft surgery, valve surgery, confirmatory factor analysis, latent mean structure analysis. CES-D ϭ Center for Epidemiological Studies Depression Scale;CABG ϭ coronary artery bypass graft surgery; CHD ϭ coronary heart disease; MI ϭ myocardial infarction; CFA ϭ confirmatory factor analysis; RWJUH ϭ Robert Wood Johnson University Hospital; UMDNJ ϭ University of Medicine and Dentistry of New Jersey; EM ϭ expectation maximization; MAR ϭ missing at random; DA ϭ depressed affect; PA ϭ positive affect; S/V ϭ somatic/ vegetative; RMSEA ϭ root mean square error of approximation; CI ϭ confidence interval; CFI ϭ comparative fit index.

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