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Learned Helplessness and Depressive Symptoms in Patients View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by ETD - Electronic Theses & Dissertations LEARNED HELPLESSNESS AND DEPRESSIVE SYMPTOMS IN PATIENTS FOLLOWING ACUTE MYOCARDIAL INFARCTION By Benjamin A. Smallheer Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Nursing Science May, 2011 Nashville, Tennessee Approved: Professor Michael W. Vollman, Ph.D., RN Professor Larry E. Lancaster, Ed.D., RN Professor Mary Dietrich, Ph.D. Professor Lorraine Mion, Ph.D. Rob Hood, M.D. Copyright © 2011 by Benjamin A. Smallheer All Rights Reserved This endeavor would not have been possible without the dedication of my support staff: My mother: for teaching me never to give up, but it was okay to fail My dogs Dakota and Savannah: for keeping my feet warm at night and never letting me work alone My children, Edward, Kevon, and Steven: for getting in trouble at school and providing many quiet evenings for me to think and work And mostly, to my husband, Robert: your unwavering dedication and support guided me thorough the many times I didn’t know if I could continue. Thank you for believing in me. Additionally, thank you for giving me permission to quit during the roughest of times. As I pushed on, I knew you were always supporting my decisions. Without you, I wouldn’t have made it. iii ACKNOWLEDGEMENTS I am grateful for the dedication and commitment of many individuals through the years while I worked on this project. I would like to express my thanks to Dr. Lynda LaMontagne for her initial guidance through my education. I would like to give my deepest and most sincere appreciation to my Committee Chair, Dr. Michael Vollman, and my interim committee chair, committee member, and editor, Dr. Larry Lancaster for their continued guidance, feedback, and mentorship which began long before I ever contemplated engaging in my Ph.D. Both of you have not only been mentors, but friends as well. Thank you for the instrumental role both of you have played in this process. To Dr. Mary Deitrich, thank you for your support and dedication through multiple revisions, questions, and educating me on the finer aspects of statistical analysis. To Dr. Lorraine Mion, thank you for being flexible and coming aboard late in the game to add a new and fresh perspective to my work. Thank you to Dr. Rob Hood, for your insight and access to my population of interest. Your specialty and expertise in the field of Cardiology greatly guided me in this project. I would like to thank Vanderbilt Institute for Clinical and Translational Research for its financial support of my dissertation study. A special thank you goes out to Dr. Frances Ward for granting me a copy of her instrument, Learned Helplessness Scale, to use in my dissertation study. I would like to express my deepest appreciation to the physicians and staff of Vanderbilt Heart and St. Thomas Heart for granting me access to your facilities and patients for participation in this study. iv Finally, I would like to thank my classmates, coworkers, friends, and family for your support, patience, and understanding of the past years. When my schedule was not flexible and I was preoccupied, each of you understood and made accommodations. THANK YOU! v TABLE OF CONTENTS Page DEDICATION ................................................................................................................... iii ACKNOWLEDGEMENTS ............................................................................................... iv LIST OF TABLES ...............................................................................................................v LIST OF FIGURES ........................................................................................................... vi Chapter I. INTRODUCTION ........................................................................................................1 Stressors in Individuals Following AMI ................................................................3 Physical Dysfunction ........................................................................................4 Psychological Distress ......................................................................................5 Psychosocial Factors Known to Affect Stress-Related Outcomes ........................6 Perceived Social Support ..................................................................................6 Perceived Self-Efficacy ....................................................................................7 Perceived Helplessness .....................................................................................7 Significance............................................................................................................8 Significance to Society .....................................................................................8 Significance to Healthcare ................................................................................9 Significance to Nursing...................................................................................12 Purpose .................................................................................................................13 Summary ..............................................................................................................13 II. REVIEW OF LITERATURE....................................................................................15 History of the Concept of Helplessness ...............................................................15 Learned Helplessness ......................................................................................16 Learned Helplessness Theory ..............................................................................19 Key Assumptions .................................................................................................19 Motivational Effects on Helplessness ..................................................................20 Cognitive Effects on Helplessness .......................................................................21 Emotional Effects on Helplessness ......................................................................22 The Evolving Concept of Helplessness ...............................................................23 Role of Perception in Helplessness ......................................................................24 Learned Component of Helplessness ...................................................................26 Cognitive Mediators of Health Outcomes ...........................................................27 Theoretical Synthesis of Helplessness in Patients with AMI ..............................31 vi Methodological Synthesis of Helplessness in Patients with AMI .......................33 Conceptual Model ................................................................................................36 Hypotheses ..........................................................................................................38 Summary ..............................................................................................................39 III. METHODOLOGY ...................................................................................................41 Design .................................................................................................................41 Definition of Terms.............................................................................................42 Helplessness ...................................................................................................42 Depressive Symptoms ....................................................................................42 Perceived Social Support ...............................................................................42 Perceived Self-Efficacy .................................................................................43 Sample and Sampling Plan .................................................................................43 Data Collection Methods ....................................................................................46 Demographic and Clinical Data ..........................................................................46 Instruments ..........................................................................................................46 Helplessness ....................................................................................................47 Depressive Symptoms .....................................................................................47 Perceived Social Support ................................................................................49 Perceived Self-Efficacy ..................................................................................49 Demographic Information Questionnaire .......................................................50 Procedure ............................................................................................................50 Data Analysis Procedures ...................................................................................51 Summary .............................................................................................................51 IV. RESULTS .................................................................................................................53 Sample.................................................................................................................53
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