Severity of illness and illness behaviour: A comparative study of coronary care patients

Abstract

Patients entering a coronary care unit (CCU) usually fall into one of two groups; those with an unequivocal diagnosis of myocardial infarction (MI) who remain to be monitored in CCU for some days before discharge to a general medical ward, and those who fail to attract a diagnosis of MI or other serious illness and are rapidly discharged to a general ward. It was hypothesized that the former group would perceive the severity of their illness as being greater than that of the latter group, and would exhibit patterns of illness behaviour in accord with this perception. In particular, it was expected that patients with MI would exhibit a greater recognition of the presence of serious illness, a greater acceptance of the sick role and a more intense affective response to illness than patients without MI. These expectations were examined by comparing illness behaviour profiles of 120 survivors of MI, with identically obtained profiles of 40 persons admitted to a CCU with chest pain but rapidly discharged with neither a diagnosis of MI or other serious illness. Only the first, relating to the recognition of the presence of serious illness, was confirmed. In all other respects, patterns of illness behaviour among survivors of MI was no different from that among patients without MI. It would seem then that patterns of illness behaviour were more influenced by the element of experience common to the two groups, admission to a CCU, than by differences either in the actual severity of the illness or the degree to which this was recognized. This suggests in turn that patients discharged from a CCU without a diagnosis of MI, are none the less concerned about the integrity of their cardiovascular systems, and if psychological intervention has been shown to benefit patients with MI, it may also be indicated for those patients with the less serious illness.