Elsevier

Resuscitation

Volume 188, July 2023, 109846
Resuscitation

Clinical paper
Protective positive psychology factors and emotional distress after cardiac arrest

https://doi.org/10.1016/j.resuscitation.2023.109846Get rights and content

Abstract

Background

There is a critical need to identify factors that can prevent emotional distress post-cardiac arrest (CA). CA survivors have previously described benefitting from utilizing positive psychology constructs (mindfulness, existential well-being, resilient coping, social support) to cope with distress. Here, we explored associations between positive psychology factors and emotional distress post-CA.

Methods

We recruited CA survivors treated from 4/2021–9/2022 at a single academic medical center. We assessed positive psychology factors (mindfulness [Cognitive and Affective Mindfulness Scale-Revised], existential well-being [Meaning in Life Questionnaire Presence of Meaning subscale], resilient coping [Brief Resilient Coping Scale], perceived social support [ENRICHD Social Support Inventory]) and emotional distress (posttraumatic stress [Posttraumatic Stress Checklist-5], anxiety and depression symptoms [PROMIS Emotional Distress – Anxiety and Depression Short Forms 4a]) just before discharge from the index hospitalization. We selected covariates for inclusion in our multivariable models based on an association with any emotional distress factor (p < 0.10). For our final, multivariable regression models, we individually tested the independent association of each positive psychology factor and emotional distress factor.

Results

We included 110 survivors (mean age 59 years, 64% male, 88% non-Hispanic White, 48% low income); 36.4% of survivors scored above the cut-off for at least one measure of emotional distress. In separate adjusted models, each positive psychology factor was independently associated with emotional distress (β: −0.20 to −0.42, all p < 0.05).

Conclusions

Higher levels of mindfulness, existential well-being, resilient coping, and perceived social support were each associated with less emotional distress. Future intervention development studies should consider these factors as potential treatment targets.

Introduction

Cardiac arrest (CA) produces substantial emotional distress in survivors who achieve functionally favorable recovery (depression up to 45%; anxiety up to 61%; posttraumatic stress up to 27%),1 which is in turn linked to worse quality of life, adverse clinical outcome, and negative subjective recovery.2, 3, 4, 5, 6, 7, 8, 9 These survivors experience continuous exposures to potential trauma, including persistent losses in cognitive and physical abilities, uncertainty of long-term prognosis, feelings of being under-resourced and underprepared to manage post-CA challenges, enduring somatic threats, and existential distress.2, 3, 10, 11, 12, 13, 14, 15, 16 In response to the growing population of CA survivors who suffer collateral emotional distress, the American Heart Association (AHA) has called for development of interventions to treat emotional distress after CA.10 Beyond the United States, the European Resuscitation Council and European Society of Intensive Care Medicine have also reiterated the need to address emotional distress post-CA in their 2021 post-resuscitation care guidelines.17

Identifying therapeutic targets is an important first step in developing emotional distress interventions for this population. To that end, we recently elicited long-term CA survivors’ recommendations for coping with survivorship challenges.12 These recommendations included practicing mindfulness (attending non-judgmentally to the present moment), fostering existential well-being (identifying sources of meaning and purpose), resilient coping (coping adaptively amidst adversity), and effectively utilizing social supports (effectively engaging social networks for functional and emotional support).12 Collectively, these are “positive psychology factors,” or psychological strengths that can be enhanced to improve emotional well-being.18 Teaching CA survivors how to hone and use these positive psychology factors could prevent chronic emotional distress post-CA, though this has not yet been tested. One previous study of ours with long-term CA survivors found mindfulness to be inversely associated with emotional distress.19 However, the CA survivors in that study were at various points in their recovery (on average 6 years post-CA), and were a convenience sample.

In this study, we tested the hypotheses that greater levels of each positive psychology factor (mindfulness, existential well-being, resilient coping, and perceived social support) are associated with less emotional distress.

Section snippets

Data collection

This prospective study was coordinated as a planned effort to assess emotional distress and positive psychology factors to consecutive CA survivors as they approached hospital discharge (within 72 hours of discharge) as part of routine care through the University of Pittsburgh Post-Cardiac Arrest Service (PCAS). We administered these measures to consecutive CA survivors between April 2021 and September 2022. We approached CA survivors who were awake and able to participate in clinical

Sample characteristics

We enrolled 110 participants (see Fig. 1 for patient flow) with mean age 59 years. Most survivors (64%) were male and non-Hispanic White (88%) (Table 1; for breakdown of out-of-hospital CA and in-hospital CA see Supplemental Table 1). Many reported an annual household income of <$50,000 (48%) and a highest education attainment as high school diploma or GED or less (46%), 6% of survivors screened positive for posttraumatic stress disorder, 32.7% for anxiety, 20.9% for depression, and 36.4%

Discussion

In this study, one in three cardiac arrest survivors experienced emotional distress at hospital discharge, despite achieving favorable functional recovery. As hypothesized, greater levels of each positive psychology factor (mindfulness, existential well-being, resilient coping, and perceived social support) were independently associated with lower emotional distress. These results provide preliminary evidence for the protective role of positive psychology factors in the CA population.

The

Conclusions

In this study, 1 in 3 cardiac arrest survivors that achieved favorable functional recovery at hospital discharge experienced emotional distress. Higher levels of mindfulness, existential well-being, resilient coping, and perceived social support were independently associated with less emotional distress. Future studies aimed at developing intervention content for emotional distress post-CA should consider these factors as potential intervention targets.

Authors’ contributions

AMP: conception and design; data acquisition, analysis, and interpretation; drafted the work; approved final version; agreed to be accountable for all aspects of the work.

KLF: data acquisition; data interpretation; revised draft for critically important intellectual content; approved final version; agreed to be accountable for all aspects of the work.

PJC: data acquisition; revised draft for critically important intellectual content; approved final version; agreed to be accountable for all

CRediT authorship contribution statement

Alexander M. Presciutti: . Katharyn L. Flickinger: Data curation, Project administration, Writing – original draft, Writing – review & editing. Patrick J. Coppler: Data curation, Project administration, Resources, Writing – review & editing. Cecelia Ratay: Data curation, Project administration, Resources, Writing – review & editing. Ankur A. Doshi: Data curation, Project administration, Resources, Writing – review & editing. Sarah M. Perman: Conceptualization, Investigation, Methodology,

Declaration of Competing Interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SMP and JE are on the Editorial Board of Resuscitation.

Acknowledgements

We thank Ciera Payne, Renee Rosseau, and the entire Pittsburgh Post-Cardiac Arrest Service for their tremendous support in the planning and data collection phases of this project.

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