Depression and Prehospital Delay in the Context of Myocardial Infarction

Abstract

Depression warrants further attention as a variable that may influence treatment seeking for MI symptoms. Results highlight the need to adequately screen for and treat depression among persons at risk for MI.

Illness Schema Activation and the Effects of Illness Seasonality on Accessibility of Implicit Illness-Related Information

“…If frequent exposure to illness primes in the environment increases accessibility of a particular illness label or identity, this will increase the chances of people rapidly detecting, labeling and acting to manage symptoms they experience. In the context of a rising pandemic, this might be effective and beneficial in Accessibility of Illness Schemata 12 initiating management of spread of the illness or treatment, if available [22,23]. However, increased accessibility of a particular schema may also increase the possibility of selfmisdiagnosis of symptoms with similar characteristics to the accessible illness [4].…”

Cognitive Science Speaks to the “Common-Sense” of Chronic Illness Management

“…Patients with MI experience chest pain, pain radiating to the shoulder (location near the heart and its felt beats), and pressure (also a sign of over exertion), and have rapid onset and rapid increases in severity of symptoms (time lines). These elements map to heart and each of them is positively and independently associated with more rapid care seeking [27]. The location of symptoms experienced by patients with CHF, e.g., problems breathing, swollen legs, and the time frames of these symptoms, e.g., chronic, slow changes before catastrophic changes, lack the pattern and rate of change for attribution to the heart [28].…”

“…These patients search for, find and interpret minor and stress-related somatic cues as signs of disease risk [43]. The studies of patients who search for and interpret every chest pain as a sign of cardiac risk provide a likely example of the feed-forward effect [27].…”

“…Specifying these elements also opens a window to understanding failures in interpersonal communication and why messages from medical and public health practitioners often fail to achieve their goals in patient and public behavior. Two studies, one a quantitative analysis of delay in care seeking following myocardial infarction (MI) [27], the second a qualitative analysis of the use of treatment for congestive heart failure (CHF) [28], provide excellent examples as to how the content of the elements affect their operation in the linking process. The studies identify four sets of elements: (1) location, (2) stimulus pattern, and two time lines, (3) rate of onset and (4) duration.…”

A Depressed Post-Menopausal Woman

“…Depression can lead to indecision and delay in seeking medical attention, as well as symptoms similar to those of acute coronary syndrome (11). Patients with inadequate coping strategies, negative views of others' trustworthiness, and low somatic awareness, as well as depressed patients, delay seeking care for acute coronary syndrome and myocardial infarction (30)(31)(32)(33). It is, therefore, important to consider emotional problems or thought disorders when assessing patients, especially when presenting with atypical complaints.…”