Psychological aspects of recovery from coronary heart disease among patients in Malaysia

The aim of this research was to identify psychological factors associated with outcomes of coronary heart disease (CHD) among patients in Malaysia. The research tested whether a model of psychological factors found to predict recovery from CHD in the West would be applicable in a collectivistic society such as Malaysia. Among the research questions posed were whether self-referent beliefs, coping styles and locus of control constructs would predict affective status for patients at the time of hospitalisation, and whether these psychological constructs would predict patients' affective status, functional status and quality of life up to nine months posthospitalisation. The research also looked at whether behavioural intentions assessed at the time of hospitalisation predict attendance at cardiac rehabilitation programmes (CRP) and the use of complementary medicine after hospital discharge. A series of studies were conducted to answer the research questions formulated based on the model developed for each study. Study 1 assessed the reliability and validity of measures developed in the West when used on a healthy Malaysian sample (N = 97). Study 2 examined the concurrent relationships among psychological variables assessed at the time of hospitalisation for 97 cardiac patients. Study 3 examined the longitudinal relationships among variables assessed in patients at the hospital and outcome variables assessed up to six months post-hospitalisation (n = 26). Study 4 (N = 77) determined the concurrent relationships among psychological variables assessed in posthospitalisation patients, and compared the psychological characteristics between posthospitalisation patients and the in-hospital patients in Study 2. A notable feature of the findings obtained from Studies 2, 3 and 4 was that whilst some psychological variables were predictive of outcome variables, others failed to support findings obtained in the West. Self-referent beliefs, for example, significantly predicted intention to attend CRP but did not significantly predict actual attendance. In addition, negative affect was relatively low for patients at in- and post-hospital assessments. Accordingly, Study 5 (N = 300) was conducted to explore possible origins of the lack of consistent findings of the studies on Malaysian cardiac samples. It assessed perceptions of illness constructs in healthy individuals. The findings of this study revealed that perceptions of illness constructs were predictive of healthful behaviors. The findings also revealed the importance of looking at specific cultural factors such as spiritual beliefs in explaining treatment-seeking behaviours in non-Western societies such as Malaysia. In conclusion, the findings of this research project highlighted the importance of studying health and illness-related behaviors within the socio-cultural contexts in which the illness occurs. Although models developed in the West may be applicable in these non-Western, collectivistic societies, the constructs assessed may not be sufficient in accounting for the variance in explaining psychological and behavioral outcomes of illness. Thus, in addition to the constructs found to be predictive of these outcomes on Western patients, psychological studies done in Malaysia should also assess mental representations of illness that are specific to Malaysians.