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題名：多向度敵意在冠狀動脈心臟病「心理生理反應模式」之驗證
作者：林宜美 引用關係
作者(外文)：I-Mei Lin
校院名稱：國立中正大學
系所名稱：心理學所
指導教授：翁嘉英
學位類別：博士
出版日期：2009
主題關鍵詞：多向度敵意；心跳變異；心血管反應；冠狀動脈心臟病；自主神經反應；脂質；cardiovascular response；multidimensional hostility；coronary artery disease；autonomic nervous response；heart rate variability；lipid
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目的：本研究目的從多向度敵意出發，檢驗敵意性格介入冠狀動脈心臟病(coronary artery disease, CAD)之心理生理病理路徑，包括慢性卅特質路徑與急性卅情境路徑，以建構多向度敵意在CAD預後之心理生理病理模式。
方法：本研究包含三個子研究，研究一以橫斷法之調查性研究，探討320名平均年齡為64.25歲(SD = 10.40)的CAD患者(女性佔29.70%)之多向度敵意與心血管反應和脂質的關係；研究二針對研究一所招募的CAD患者進行三年縱貫追蹤研究，探討多向度敵意對CAD患者預後指標和死亡的預測力；研究三採用實驗室研究，以98名平均年齡為61.49歲(SD = 10.56)的CAD患者(女性佔11.80%)進行生氣回憶作業，以檢驗敵意行為型態與自主神經反應之關連性。
結果：研究一在女性樣本中發現，壓抑敵意與低密度脂蛋白有正向關連性(β = .394, p < .05)，但多向度敵意無法預測休息狀態下的心血管反應。研究二在三年追蹤期間發現，CAD患者因心臟問題住院和死亡之預測因素中，表達敵意具正向關連性(分別為β = .118, p < .05與β = .590, p < .05)。研究三發現表達敵意和壓抑敵意在自主神經具有不同的反應型態：表達敵意與生氣期之交感神經(sympathetic nervous system, SNS)指標有正向關連性(β = .402, p < .05)，與恢復期之副交感神經(parasympathetic nervous system, PSNS) 指標有負向關連性(β = -.332, p < .05)；而壓抑敵意與基準期和中性期之SNS與PSNS共同調控指標有正向關連性 (分別為β = .366, p < .05與β = .332, p < .05)。
結論：本研究證實多向度敵意中之表達敵意和壓抑敵意，在CAD患者之自主神經具有不同的心理生理病理反應路徑：表達敵意性格的CAD患者可能因PSNS弱化，而在生氣情境呈現SNS過度反應，進而增加預後期間心臟問題住院或死亡的危險；壓抑敵意性格的CAD患者於預後期間可能因經常警覺環境威脅，而引發SNS與部份PSNS慢性活化，進而導致慢性的脂質路徑。本研究依據上述結果所建構之多向度敵意在CAD預後之心理生理病理模式，可做為未來臨床心理介入之參考依據。
Objective: The aim of this study was to develop the psychophysiopathological model of multidimensional hostility in order to predict the prognosis of patients with coronary artery disease (CAD). The influences of multidimensional hostility on the psychophysiopathological process of CAD through chronic/ trait pathway and acute/ state pathway were examined in the present study.
Method: This study consists of three sub-studies. In the first sub-study, 320 CAD patients (age = 64.25 ± 10.40; 29.70% female) were recruited and investigated the relationships between multidimensional hostility, cardiovascular response, and lipid through the cross-sectional research design. The longitudinal research method was later utilized in the second sub-study to probe whether multidimensional hostility could predict the prognosis and death of the 320 CAD patients. In the last sub-study, the investigators administered the anger recall task to additional 98 CAD patients (age = 61.49 ± 10.56; 11.80% female) in order to develop a theory of hostility behavior patterns in responses of automatic nervous system.
Results: The first sub-study indicates that suppressive hostility can predict low density lipoprotein in female CAD patients (β = .394, p < .05); however, no significant correlation between multidimensional hostility and resting cardiovascular response was found. The second sub-study, a 3-year longitudinal investigation, shows that expressive hostility can predict both cardiac hospitalization (β = .118, p < .05) and death (β = .590, p < .05). The results of the last sub-study reveal that expressive hostility and suppressive hostility have different automatic nervous system response patterns. Expressive hostility can predict sympathetic nervous system (SNS) activity under anger situation (β = .402, p < .05) and parasympathetic nervous system (PSNS) withdrawal under recovery (β = -.332, p < .05). In addition, suppressive hostility can predict both SNS and PSNS activity under baseline and neutral situation (β = .366, p < .05 and β = .332, p < .05 respectively).
Conclusion: This present study indicates that expressive hostility and suppressive hostility have different psychophysiopathological pathways in autonomic nervous system. The CAD patients with expressive hostility personality tend to have a poor prognosis due to SNS hyperactivity under anger situation and/ or PSNS withdrawal under recovery. This psychophysiological response may increase the risk of cardiac hospitalization and death. The CAD patients with suppressive hostility personality, on the other hand, tend to have a poor prognosis when they perceive threats or a harmful situation that may elicit both SNS and PSNS activity. This psychophysiological phenomenon may eventually lead to the chronic lipid pathway. This study has created the psychophysiopathological model of multidimensional hostility that can be used to predict the prognosis of CAD patients. It is expected that future research can use this model as a basis to establish the intervention programs for CAD patients.
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