result discussion - shodhgangashodhganga.inflibnet.ac.in/bitstream/10603/640/12/12_chapter4.pdf ·...

CHAPTER 4

RESULT & DISCUSSION

b Result & Discussion of MANOVA b Result & Discussion of ANOVA

> Result & Discussion of Disriminant analysis b Comparison of mean values of all variables

> Results & Discussion of Chi-square test

The present study aims to find out the psychological correlates of cardiovasculardiseases.

For this a set of tools comprising of 18 psychological variables and certain demographic

variables and 10 groups of subjects (8 cardiac patient groups, one non-cardiac patient group,

and one normal group) were included.

TO make the study more fruitful and effective two types of group comparison have been

made. As a first criterion, the total sample (500) has been divided in to three groups (Three

group classifications) viz., cardiovascular patient group (400), non-cardiac patientgmup (50)

and normal group (50). In order to get a clear picture about the different cardiovascular

dise~es, a second criterion was used. For this, the total sample (400) has been again

divided in to eight groups.

Since the present study involves group comparison based on a number of independent

variables, the technique of multivariate analysis of variance (MANOVA) has been found

suitable to bring out systematic behavioural differences among the groups. The result and

discussion of which are presented in section 4.1.

This was followed by one-way analysis of variance (ANOVA) to identify those variables

producing significant group differences. This has been done for the three groups and the ten

group classification for all the variables studied. Multiple range analysis using Scheffe's

procedure is then used to find out the specific group, which differ significantly on all the

variables. The details are presented in section 4.2.

Thediscriminant analysis is mainly used to identify those psychological variables, which are

most discriminative among the different subgroups selected for the study. Section 4.3 deals

with the result and discussion regarding the discriminant analysis.

The mean values of all the variables have been compared on the basis of patient groups, the

details of which are presented in graphs (section 4.4). An attempt has also been made to

compare the results with the two control groups.

Finally the demographic variables are taken and the Chi-square analysis has been

attempted and the result and discussions are p m t e d in section 4.5.

4.1 Results and Discussion of the Multivariate Analysis of Variance (MANOVA)

As mentioned earlier, the present study is an attempt to identify the important psychological

variables, which differentiates groups of normal subjects, general patients and cardiac

patients. The cardiac patients consisted of eight subgroups, viz., those which suffered

myocardial infarction, angina, cardiac surgery, essential hypertension, arrhythmia,

atherosclerosis, endocarditis and pericarditis. Thus the study involved, detailed exploration of

group differences of the subjects classified into either three groups or ten groups.

The technique of multivariate analysis of variance (MANOVA) has been found to be suitable

to bring out systematic differences among the groups, as the study involved group

comparisons based on a number of independent variables. A significant multivariate F value

allows one to conclude with confidence that the groups do indeed differ among themselves at

least in some of the variables. One may then proceed with univariate F tests to identify those

variables producing significant group differences.

In the present study MANOVA is done separately for the two types of classification of the

sample, viz., threegroup classification and ten-group classification. Results of MANOVA for

the three-group classification are given in table 4.25. The approximate F value obtained is

4.619, which shows that there is significant difference among Vlethreegroupson thedifferent

variables under study.

Table 4.1 Multivariate tests of significance (S=2, M=9, N=237112) for the three-group classification

Test name

The hypothesis formulated for the threegroup classification is that there will be significant

difference among the cardiac patient group and the two control groups (normal and non-

Pillai's trace

Value

0.337

Error Significance QFF' Approximate 'F'

4.619

DF

42.00 956.00 0.000 1

cardiac patients) on the eighteen different variables. Since there is evidence for significant

difference among the three group (table 4.1), it can be concluded that the normal (N=50),

non-cardiac patients (N=50) and cardiac patients (N=400) differ significantly, when the 18 -

variables are taken together.

Table 4.2 shows the results of MANOVA for the tekgroup classifcation on the different

variables under study. Here the hypothesis is that there will be signifmnt difference among

the different cardiac groups, non-cardiac patients and normal on the eighteen psychological

variables. The approximate 'F' value obtained here is 4.316, which shows that the ten

subgroups differ significantly on the different variables under study.

Table 4.2 Multivariate test of significance for the ten group classification

. I Pillai's trace 1 1.434 / 4.316 1 189.00 1 4302.00 1 0.000 1

Test name

Considering the results of the MANOVA for the tengroup classification, there is evidence to

show that the eighteen variables under study have an overall ability to discriminate between

the above said groups. With a view to identify those variables, which produce significant

group differences, univariate F tests were conducted separately for each of the variables. The

results thus obtained are presented in detail in the next section.

Value Approximate 'F' DF Error Significance of 'F'

4.2 Result and Discussion of Anatysi of Variance and Multiple Range

The present section deals with the results and discussion of one-way analysis of variance

and multiple range analysis using Scheffe's test, for the three gmups and ten-group

classification.

At first, the total sampte (N=500) is divided into three groups, viz., normal (N=50), no*

cardiac patients (N=50) and cardiac patients (N=400). Based on this threegroup

classification, oneway analysis of variance and Scheffe's test has been done separately for

all the variables under study

Following this, an attempt is made to test the significance of difference among the 10 different

groups. For this, the cardiac patients (N=400) have been divided into eight gmups based on

their diseases. These gmups are Myocardial Infarction, Angina, Essential hypertension,

Cardiac surgety, Artheroscterosis, Arrhythmia, Endocarditis and Warditis feqectively with

a sample of 50 patients each. Based on the ten group classification (eight cardiac patient

group, one normal and one noncardiac group) the one way analysis of variance and multiple

range analysis has been used to find out which groups differ significantly.

There are altogether 18 psychological variables and the resuits and discussions forthe the+

group dassifrcatii foftowed by the 10-group dassification for each variabte are presented

here.

4.2.1 Family Stmss

Tabte 4.3 summarises the results of one way analysis of variance among the various gmups

for the variable 'family stress'. The 'F' ratio is found to be 7.49 and it is significant at 0.01

level. This shows that, time is significant difference among normal, noncardizx and c n d i

groups in the variabte family stress.

-72- Table 4.3 Results of ANOVA on the three group classification on family stress

-- r source r ~ F T - L r n o f Squares I Mean Squares I I!=' Ratio 1 - - -

41660.20 83.82 7.49-

-- 42915.99

"Slgnifcant at 0 01 level

Table 4.4: Comparison of the three groups on family stress

r h n ( S D ) I

Groups /%up I-NS 1 Gmup 2-NCP Gmup 3-CP

L 3 2 . 7 3 (9.37) -- -.. Group3-CP +

'Signficant at the 0.05 level

In order to identify the pairs of groups which differ significantly from each other on family

stress, the technique of multiple range analysis of the mean values, has been attempted. The

results thus obtained (table 4.4) show that cardiac patients score significantly higher

(M=32.73) than the normal (M=27.68) and non-cardiac patients (M=30.52) in family stress

where M is the mean value. Since there is significant difference between cardiac patients and

normal, further analysis on the ten-group classification also has been done to find out the

specific groups which differ significantly.

Table 4.5 summarises the analysis of differences among the ten groups in the variable family

stress. The obtained 'F' ratio is 13.07, which is significant at 0.01 level. This shows that there

is significant difference among the various groups studied.

Table 45 Results of ANOVA based on the ten group cla!ssificatiin on family stress

L - ..LA.- 4

"Significant at 0.01 level

-73- Table 4.6 Comparison of the ten groups for family stress

'Signfieanfly different at the 0.05 level

In order to identify the pairs of groups which differ significantly from each other on the

variable, here again the multiple range analysis of mean values has been attempted. The

. , results are shown in table 4.6, which shows that the group with MI, EH, EN and AN score

significantly higher than the other groups in family stress. It is also noticed that the MI group

scored the highest (Ml=39.96) in this variable and they differ from all the other groups except

AN, EN and EH. A graph was plotted based on the mean values and presented as figure 1.

From the above results, it is seen that the cardiac patients differ significantly from the two

control groups, viz., normal and non-cardiac patients on family stress. Eventhough there is

difference in the mean values of cardiac patients (32.73) and non-cardiac paijents (30.52) it is

not significant. On the other hand the normal differ significantly from the cardiac merits. This

can be attributed to the fact that the family stress is a contributing factor in various cardiac

diseases. Among the cardiac groups MI, EH, EN and AN differs significantly.

Family stress measures various aspects related to family life, such as lackof satisfaction with

the home atmosphere, unreasonable demands, conflict among family members, ill health of

family members, lack of freedom and independence uncomfortable physical facilities etc. In

thecaseof cardiac patients, especially MI, EH, EN and AN, the abovementioned aspectsof

family stress are comparatively higher than the other groups.

-75 Harrel(1980) pointed out that the hypertensives may be stress sensitive showing stronger

blood pressure response and taking longer time to retum to normal state once their blood

pressure has been raised in response to stress. Since in the family there may often bestress

situations that evoke reactions in the individual and considering the stress sensitive natureof

the hypertensives, it is only natural to expect that the hypertensivesfind the familial stressful

events as highly stressful.

Any unpleasant situation in an individual's life can lead to stress, especially among the

members of the family. In the abovediscussion, it is seen that angina, essential hypertension,

endocarditis and myocardial infarction groups got higher scores on family stress. The

physiological symptoms of these diseases develop sudden changes and restrictions in the

lifeof a patient, which may lead to unsatisfactory family life and thereby, createfamilystress.

This can be attributed to higher scores obtained by the said groups on family stress.

Thus, it can be concluded that the three group and ten group classification of the sample

clearly indicates significant difference among the different groups on family stress.

4.2.2 Social Stress

The details of the results of ANOVA for difference among the mean scores on social stress

with respect to the three groups, viz., normal, noncardiac patients and cardiac patients are

shown in table 4.7. Here the 'F' ratio (4.02) is significant at 0.01 level, showing thatthe three

groups differ significantly on the variable social stress. The multiple range analysis using

Scheffe's procedure was cmducted to find out which of the means obtained from the three

groups differ significantly. Even though the 'F' ratio is significant the values on multiple range

are not significant.

Table 47 Results of ANOVA based on the three group classification on social stress

PFffl Total 499 32445.97

"Signillcant at 0.01 level

- Source DF Sumof Squares Mean Squares 'F' Rrdlo

In order to make it more specific the ten-group analysis has also been canied out. Here the

'F' value (7.99) is significant at 0.01 level. The multiple range analysis for the ten groups

-76-

Table 4.8 : Comparison of the three groups for social stress

shows that normal, non-cardiac patients and atherosclerosis (ATH) patients show signifcant

difference. The atherosclerosis group (M=35.90) differ significantly on the variable social

stress from the ARR, PE and EN groups. The non-cardiac patient group (M=33.28) differ

significantly from the ARR groups and PE group. The normal differs significantly from the

- ~p

Mean (SO) 1 Groups [l_l~s GroupZ-NCP

1 ~

-

- .~

33.28 (7.75) GroupZ-NCP -.-

30.49 (7.86) Gro~p3-CP

ARR group alone. The graph presented as figure 2 gives a comparison of the mean values.

Group3-CP

-- -

Table 4.9 Results of ANOVA based on the ten group classification on social stress -----T.DF.I r source urn of Squares Mean Squares 'F' Ratio

Total 32445.97 "Significant at 0.01 level

Table 4.10: Comparison of the ten groups on social stress - ~ -. ~~- ~ ~

/---M&-(sD) 1 Groups I ARR [ PE / EN AN ~ T ~ ~ ~ ~ c ~ s ~ [ C P ~ ~ /

-78- Social stress measures factors related to social relationship, unemployment, violence, noise,

crowding, pollution, cramped living conditions, loneliness, isolation etc. Social stress has

been understood as a condition of tension between environmental demands on an individual

and the resources with which to adapt to those demands. Adaptation involves the capacity to

control environmental demands; to moderate their impact This depends on the personality

attributes of the individual and his coping strategies. When the individual experiences failure

in adaptation to environmental demands, the situation is experienced as highly stressful.

In their study, Orth-gomer et al(1993) reveals that attachment and social integration were

lower in coronary heart disease patients. This runs contradictory to the findingsofthe present

study, where the different cardiac groups got lesser scores on the variable social stress,

when compared to normal and general patients. This may be due to the particular cultural

and envimmental conditions, prevailing in the state of Kerala. Among the cardiac group the

artheroscferosis group is the only one which got higher scores on social stress.

Arthemcierosis is a generalised disease with narrowing the occlusion of the arteries.

4.2.3 Personal Stress

Summary of anatyss of vanance of personal stress scores ofthe t h r e e g r o u p d ~ ~ is

shown in taMe4.11. It may be seen that the 'F' ratio of 8.B is significant at 0.01 level. H e

multiple range analysis also has been done, which is presented in table4.12. It is found that

the cardiac pattent group (M= 37.81) &Hers signifcantly fm normat (W 33.23. The cardia:

groups as such are found to experience more personal stress compared to rrormal.

Tabte A l l Results of ANOVA based on the three group cfa~sifccation on personal stress

Wlthtn Gmup

Total " 5 i n t at OAt lev&

497

499

35468 79

36691.03

71.37 8.56"

I ..A -- ~_ I - 1 - 1 33.20 (10.04) / Group I -NS I 1 34.80 (7.63) 1 Group 2 -NCP I, 37.81 (8.33) -~ Group 3 -CP

*Significant at the 0.05 level

Based on the tengroup classification 'F' ratio (table4.13) is found to be 8.05 and it is

significant at 0.01 levels. Mulfiple range analysis for the ten group (table4.14) indicates that

the cardiac surgery (CS) group differs significantly from EN, ARR, EH, ATH, AN, MI and PE

groups. Based on the mean values a graph was plotted and presented in figure 3.

-79- Table 4.12: Comparison of the three groups on personal sbss

j I Mean (SD) I I

Table 4.13 Results of ANOVA based on the ten group classification on personal stress

I Source Sum ofSquares I

I I I Mean Squares

I I 'F' Ratio

Group 5CP Groups

499 1 36691.03 lTotal--L-.. - I "Signifitantat 0.01 level

! Group I-NS 1 Group 2-NCP

Table 4.14: Comparison of the ten groups on personal stress

Personal stress usually originates from within the individual concerned. People often use

their emotional condition to evaluate their stress. Personal stress measures factors related to

38.26 (12.82) ' ATH (8)

worry, anxiety, fear, anger, sensitivity, depression, conflict etc. People are likely to find

'Signifcant at 0.05 level

*

' ---- ~~p

38.62(7.17) 40.42 (5.95)

AN(4) NII (3)

' 41.14 (5.75) 1 PE(I0) ~

I

-81-

conflict as stressful when the choices involve many features, and the opposing motivational

f o w s have fairly equal strength. Research in this field, by Shukla (1989) and Stanin et al

(1993) support the findings of the present study.

When the threegroup analysisis attempted the difference between the groups is highly

significant, especially between the cardiac patients group and normal. This can be attributed

to the disease conditions of the cardiac patients group, which leads to worries, anxiety, fears,

conflict etc.

The results of the ten-group analysis also show that there is significant difference among the

various groups in the variable personal stress. Except cardiac surgery (CS) group, all the

other cardiac patient groups have higher score on personal stress. In addition, normal group

differs significantly from MI and PE groups The non-cardiac patient group does not exhibit

any significant difference from the other groups. Thus the cardiac surgery (CS) group, non-

cardiac patients (NCP) and the normal form a homogeneous subset of the variable, personal

stress. The cardiac surgery group includes patients who had undergone surgery due to

different cardiovascular diseases. Since they have overcome the critical stage of surgery,

they seem to be more confident and are free from the personal stress. This may be a reason

for them having the lower scores on personal stress. On the other hand, all the other sub

groups of cardiac patients got higher scores as a result of the specific physical symptoms,

which leads to wrsonal stress.

4.2.4. Occupational Stress

The result of the analysis of variance for the three-group classification on occupational stress

is shown in table 4.15. The 'F' ratio calculated is 1.90, which is not significant; hence the

multiple range analysis has not been done.

Table 415:Results of ANOVA based on the three group on occupational stress

/ S o u r c e n 7 - S u m ~ u a r e s I Mean Squares 'F' Ratio

Between Groups Within Gmups Total

2 497 499

155.80 82.01

311.59 40760.60 41072.19

1.90

-82- Table 4.16: comparison of the three groups on occupational stress

Group 1-NS

The table 4.17 shows that the 'F' ratio for ten group classification is 4.52 and is significant at

0.01 level. The multiple range analysis forthe ten group classification is shown in table 4.18.

28.06 (10.50) ~~

31.32 (9.02)

30.45 (8.87)

This indicates that only essential hypertension (EH) group differ significantly from peridi t is

Group 2-NCP

(PE). Even though there are variations in the mean scores of other cardiac groups and

Group 3-CP

--

Group I -NS

control groups, they are not significant. The mean values of different group were compared

Group 2 -NCP

Group 3 -CP --

and presented as figure 4.

Table 4.17 Results of ANOVA based on the ten group on occupational stress

-~ ~~~.

--

T O F T Ltn of squares 1 Mean Squares 'F' Ratio

--

Between Group ~F~~~ 4.52* 1 Total

- - 41072 19 "Signifcant at 0.01 level

Table 4.18 : Comparison of the ten groups on occupational stress

'SgnWnt at 0.05 level

Almost all people at sometime in their life experience stress related to their occupation. Often

this stressful situation is minor and of a short range and has little impact on the person. But

for many people this is intense and continuous. Occupational stress is affected by factors like

the characteristics of job, role of the person in the organisation, interpersonal relations,

organisational structure, organisationai climate etc.

In the present study the three groups, viz., normal, non-cardiac and cardiac patients do.not

differ significantly in the effect of occupational stress. This means that their personal l ie is not

linked with their occupations i.e., health I unhealthy is not connected with the factors involved

in occupational stress.

While analysing the results of ten group classification, the EH group got the highest

significant score. Essential hypertension is usually associated with normal health and well

being for several years. This will automatically affect their work performance and leads to

occupational stress. A few studies conducted in this area have reported contradictory results.

Some of them agree with the results of the present study, while others are against it. The

result of ten group classification shows that only the EH gmup differ significantly from the PE

group. One of the pioneering studies by Friedman et al(1958) found thatwhmwork pressure

was greatest, serum cholesterol rose and blood-clotting time was accelerated. Serum

cholesterol fell and clotting time returned to normal under conditions of reduced work

pressure. On the other hand, a study by Albright et al(1992) shows that lower levels of job

demands and job strain were associated with a higher prevalence of hypertension.

4.2.5. Type A Behaviour

Summary of analysis of variance for the variable type A behaviour scores of the three-group

classification is presented in table 4.19. The 'F' ratio (9.36) is signifcant at 0.01 level. The

multiple range analysis is carried out and presented in table 4.20. Here the results show

significant difference between noncardiac patients and normal with cardiac patients.

.

Between Groups 62.32


-85-

Table 4.19: Results of ANOVA based on the three-group on type A behaviour

Table 4.20: Comparison of the three groups on type A behaviour

TwT sum of squares 1 Mean Squares 'F' Ratio

'Significant at 0.05 level

-- /-r Groups -[%Yp2-NCP Group I-NS

To make the result more specific, analysis on ten-group classification is also done and

presented in table 4.21. Here the 'F' ratio is significant at 0.05 level. Multiple rangeanalysisof

Group 3-CP

the different sub groups does not show any signifcant difference. Though the result does not

show any significant difference, graph (figure 5) is presented to know the mean differences.

Table 4.21: Results of ANOVA based on the ten-group classification on type A behaviour ~~ ~ ~ - - . r "ume I O F ( sum of squaws T squares 1 'F' Ratio 1

_ L 4 9 9 i 3 4 3 5 . 4 6 'Signifkant at 0.05 level


Within Gmups 3271.14

Table 4.22: Comparison of the ten groups for type A behaviour

18.26 6.68 2.74'

-87- The type A behaviour pattern included ambitiousness, aggressiveness, competiCveness and

impatience, and specific behaviour such as alertness, muscle tenseness etc. Fnedman and

Rosesman (1974) described type A behaviour pattern as a particular complex of traits

including excessive competitive drives, aggressiveness, and impatienceand hunied senseof

time urgency. They have found out an association between type A behaviour and coronary

heart disease.

The one-way ANOVA shows that the scores of 3 groups on the dependent variable type A

behaviour, the cardiac group exhibit more of type A behaviour patterns than the normal group

and the non-cardiac group. Hence it can be assumed that it is this type A behaviourexhibited

by the cardiac groups that explains why these groups find the life events more stressful

compared to the normal and non-cardiac groups who show only border line type A behaviour.

A study by Tagawa and Hosaka (1990) shows that the behaviour pattern might be an

independent coronary risk factor. Another study by Kanshik et al(1991) also states that the

important precipitating factor for both male and female coronary heart disease pa&nts is type

A behaviour pattem. The results of the present investigation also assert that the non-cardiac

patients and normal differ significantly from the cardiac patients.

Eventhough the 'F' ratio is significant at 0.05 level when analysing the result based on the

ten-group classification, the multiple range analysis does not show any difference. The

normal, non-cardiac patients or the eight different cardiac patients groups do not have any

significant impact on type A behaviour pattern. The mean values obtained for the ten groups

(table 4.22) indicate that the non-cardiac patients (M=8.60) and normal (M=8.98) have the

least scores on type A behaviour when compared to the different cardiac patient groups. A

number of studies have been conducted in this area the results of which are compared

against the present findings. Freeman et al(1984) and Follick et al(1990) shows that there is

no relation between type A behaviour and arrhythmia. Langeluddecke et al(1988), in their

study on atherosclerosis patients also failed to indicate a relationship between type A

behaviour pattem and coronary vessel disease. On the other hand, a study by Lazara et al

(1993) on hypertensive patients showed contradictory results.

-88-

From the above analysis it is clear that the three-group classification shows significant

difference between cardiac patients and the two control groups. Subgroup wise analysis does

not show any significant difference between the different cardiac disease groups.

4.2.6 Extroversion - Introversion (E - I) The result of the analysis of variance for the variable E - I obtained for the three-group

classifications are shown in table 4.23. As the 'F' ratio (11.41) is found to be significant at

0.01 level, the specific mean difference are calculated by the multiple range analysis, and

given in table 4.24. The table shows that non-cardiac patients (M=11.54) and cardiac patients

(13.75) differ significantly in the variable E - 1.

Table 4.23: Results of ANOVA based on the three group classification on extroversion- introversion

lSour=B- - ~ ~ -~ -~ ~ . , ~ ~.~

DF I Sum of Squares Mean & ~ a & i ~ l

Total PA

'"Signaicant at 0.01 level

Table 4.24: Companson of the three groups for extroversion-introversion -

Groups I Group 2-NCP Group 1-NS Group 3-CP

'F' ratio is calculated forthe ten group classification and is found to be significantat0.01 level

(table 4.25). Here also the specific mean difference are calculated using multiple range

analysis (table 4.26). The results obtained shows that the non-cardiac patient group differs

significantly from ATH, MI and EH groups. The mean scores indicate that eight subgroup of

cardiac patients show more extroverted tendencies, especially the ATH, MI and EH groups,

when compared to the non-cardiac patients and normal. The graph presented in figure 6

shows the comparison of mean values.

1 13.75 (3.37) 1 Group 3 -CP 'Significant at 0.05 level

Table 4.25 Results of ANOVA based on the ten group classification on extroversion- introversion

-- .- -

ViiZ T DF r sumof squares ~ u n ~ g u a n s 1 'F' Ratio 1

A high score indicates extroversion and low score indicates introversion. Higher scores on E - I was found to be associated with cardiac patients than the other two groups on the three-

group classification. In the ten-group classification there exists significant differences

between non-cardiac patients and different sub groups of cardiac patients. Among the

different sub groups of cardiac patients EH, MI and ATH groups differ significantly from non-

cardiac patients. This means that they have more extroverted traits than the other sub

groups. This can be seen from the mean values of EH (M=14.88), MI (14.24) and ATH

(14.18) given in table 4.26.

-

Total 499 5397.08

Table 4.26 : Comparison of the ten groups for extroversion-introversion

12.54 (3.16) CS(5) 12.56 (2.81) PE(10)

12.84 (2.78) NS (1)

13.74 (2.51) ARR (7)

13.84 (4.05) AN (4) 14.02(3.10) EN(9)

14.24 (2.57) MI (3)

14.88(4.58) l E H ( 6 ) ' *Signifcant at 0.05 level

As shown in the description of the variable the typical extrovert is very outgoing, likesfast life,

prefers changes and is adventurous. He is highly sociable and has plenty of Mends. Meny


52.23

- 10.06 - 5.19"

I

Em

-

-91-

events and practical jokes keep him very active. He prefers company to sitting alone and

reading or studying. He is impulsive and hence not always reliable, likes spur of the moment

decisions and enjoys taking risks. He is carefree, easygoing, optimistic but aggressive and

tends to be short-tempered. His feelings are not kept under tight control.

The typical introvert is quiet and reserved. He prefers a cornerto himself and is fondof h k s

rather than people. He has moments of self-introspection and opens up to only intimate

friends. He likes planning ahead and work according to schedule. He leadsanorderly life and

takes everyday events with proper seriousness. He is pessimistic and cynical sometimes. He

does not like to experiment with traditional values and ethics. He is seldom aggressive. His

feelings are kept under close control and do not lose temper easily.

From the above findings it is clear that the non-cardiac patient group has more introverted

traits than the normal and other cardiac patient groups. Shukla (1995) in his study on CHD

patients found that there is no significant difference between CHD and general population on

E - I dimension. A detailed analysis by Shukla showed that Angina (AN) and Myocardial

Infarction (MI) patients did not have any significant difference on E - I and Neuroticism

dimensions of personality. It is contradictoty to the findings of the present investigation.

4.2.7 Neuroticism

Analysis of variance of the Neuroticism scores of the three groups is given in table 4.27. As

the 'F' ratio (4.88) is found to be significant at 0.01 level, the specific mean differences has

been calculated using multiple range analysis. The result shows significant diierence

between normal and cardiac patients groups (table 4.28).

Table 4.27 Results of ANOVA based on the threegroup classification on neuroticism

7- T7~r-r I s G Z ~ q u a r e s 1 Mean Squares 'F' Ratio

~etween ~ r o u F 1 liT -- --jiTTTp Wihin Groups -- 9867 24 4.88"

Total 10060 90 _ L - I I I


-92-

Table 4.28: Comparison of the three groups on neuroticism

Groups Group 1-NS Gmup2-NCP Group 3-CP I --- ~ ~~~ ~ --


The 'F' ratio obtained for the tengroup classification is highly significant (0.01) (table 4.29). A

detailed analysis of the different subgroups using Scheffe's procedure, shows that there is

significant difference between PE and AN, NS, MI, CS, EN, NCP and EH. The ATH groups

also differ significantly from AN group (table4.30). Graph presented in figure 7 shows the

comparison of mean values of different groups.

Table 4.29 Results of ANOVA based on the ten-group classification on neuroticism

I Source Sum of Squares Mean Squares I RdiO I

Table 4.30 : Comparison of the ten groups for neuroticism

. - - - l-~~. ;..-


WIhin Groups ~ 1 ~ 6 ~ ~ % - ~ ,26

Total 499 10060.90 ...- -~


184.52

17.22

.-

Mean (SD)

. ~

I I .OO (3.90)

11.22 (6.06)

11.64 (4.06) 11.78 (4.06)

12.10 (4.82)

12.58 (3.41)

13.56 (4.00)

14.32 (3.38) - -

10.48"

Groups AN N

AN (4)

NS (I) MI (3)

CS (5)

EN (9) NCP (2)

. .. .

EH (6) ARR (7) - ~~ ~-


~~~ ' t

14.62 (4.49) ~. ~- -

ATH (8) ~

t 17.04 (2.21) ~

PE (10) * f t

-94-

Individuals who get high scores on Neuroticism tends to be emotionally over responsive and

have difficulties in returning to a normal state after emotional experiences. Such individuals

frequently complain of vague somatic upsets of a minor kind such as headache, digestive

troubles, insomnia, backaches etc and also reports many worries, anxieties and other

disagreeable emotional feelings. Such individuals are predisposed to develop neurotic

disorder under stress.

Neuroticism may be considered as measures of personality trait indicating how prone the

individual is to experiencing anxiety in a given setting. In the present analysis of the three

group classification, the 'F' ratio is found to be significant at 0.01 level. This indicates thatthe

three groups differ significantly on the variable neuroticism (N). The specific analysis shows

that the cardiac patient group differs significantly from the normal. Even though there is a

slight difference in the mean value between non-cardiac patients (12.58) andcardiac patients

(13.26) it is not significant. Shukla (1995) in his study proved that CHD patients differ

significantly on Neuroticism from the general population. This finding agrees with the present

results and at the same time asserts that cardiac patients have neurotic personality traits.

The results of ten-group classification indicate significant difference between normal and

cardiac group (F=10.48", table 4.29). In order to be more specific, the multiple range

analysis has been done and the results indicate the following facts. There is significant

differences between PE and AN, NS, MI, CS, EN, NCP and EH. Apart from thistheAN group

differs significantly from ATH. This implies that the PE group score higher on Neuroticism

than the other subgroups. Among the various sub groups PE (17.04), ATH (14.62), ARR

(14.32) and EH (13.56), have high scores on Neuroticism. This suppohs the fact that the

disease conditions can create neurotic traits in a patient. Studies by Sainsbury (1964) and

Coelho et al (1989) reports that patients with hypertension differed significantly from the

control groups of patients, by exhibiting higher levels of Neuroticism. Llyod and Cawley

(1983) in their study found that MI patients score high on neuroticism than thecontrol groups.

Similarly Wisow et al (1990) found a positive relationship between Neuroticism and

Artherosclerosis (ATH). On the other hand Shukla (1995) in his study on Angina (AN) and

-95- Myocardial Infarction (MI) patients found no significant difference caused by Neuroticism on

dimensions of personality. Though there are contradictory findings on this variable, most of

them are supportive to the present result. Thus, it can be concluded that Neuroticism plays a

major role in different cardiac diseases.

4.2.8 Stable Temperament

Summary of analysis of variance for the variable stable temperament of the three groups is

presented in table 4.31. The observed 'F' ratio (6.81) is significant at 0.01 level. The multiple

range analysis of the three groups also shows that there is significant difference between

non-cardiac patients and cardiac patients with normal (table 4.32).

Table 4.3l:Results of ANOVA based on the three group classification on stable temperament

) DF Sumof Squares 1 k n ~ g u a r e s 1 IF' Ratio 1 pp~j=q-=qq

Total --- - 13946.67


Table 4.32: Comparison of the three groups for stable temperament

- - 1 - - --t k ~ i ~ l j / Group 2 -NCP


The total sample is divided into ten sub groups for which the 'F' ratio has been obtained and

found to be significant at 0.01 level (table 4.33). The subgroup wise analysis using Scheffe's

Procedure is given in table 4.34 also shows that there is significant differences between PE

and AN, CS, EN, MI, ARR, EH and NS. The mean values of different group were indicated in

the graph on figure 8.

-96-

Table 4.33: Results of ANOVA based on the ten group classification on stable temperament

Within Groups 12193.16 24.88 7.83-

Total 13946.67 --


. . _ E L [ OF sum of *~ares I i - T Mean Squares

Table 4.34 : Comparison of the ten groups for stable temperament

'F' Ratio

- ~~~-


Mean (SO) I Groups / PE ATH ; NCP AN

(10) .(8) (2) (4) i

The variable stability measures emotional maturity, evenness of mood, stability in decisions,

optimism, alertness, firmness, endurance and lack of fatigue, worries, depression, guilt,

anxiety etc. The result of the present investigation presented in table 4.32 shows that the

three groups differ significantly on the variable stability. The multiple range analysis given in

table 4.34 shows that the normals differ significantly from non-cardiac patients and cardiac

patients. With a high mean score the normal (37.98) proved to be more stable than the non-

cardiac patients (34.18) and cardiac patients (35.71). This result is in agreement with the

general concept that any condition that affects the mental or physical health of an individual

can affect his stability of temperament.

The ten-group analysis also shows significant difference among the groups. When we

consider each sub group separately, which is shown in table 4.34, it can be seen that the PE

CS

(5) b E 8 ) + ~ - F'E ~- (10) + 1 - 1 . + . c.- 33.60 (6.40) ATH (8) I I i 1

1

EN MI

(9) (3)

ARR

(7)

EH

(6)

NS

(1 )

-98-

group scored the least (M=31.70). This means thatthey lack optimism, alertness etc, when

compared to other subgroups, excepting atherosclerosis and non-cardiac patients.

Pericarditis is an inflammatory disease, the sudden onset affect the functioning of the heart,

which leads, them to the conceptthat they are having a serious illness which eventudly leads

to change in their attitudes, perceptions and even in their over all behaviours. Among the ten

subgroup, the normal (NS) score the highest (M=37.98). They differ significantly from ATH

and PE groups. Thus the normal (NS) are found to be more stable in their attitudes,

perceptions, opinions and in all their behaviours. It can be concluded that, when we consider

the three-group classification, there exists notable difference among them, while the

individual analysis does not support the said result.

4.2.9 Objective Temperament

The result of Anova for the three groups on objective temperament is presented in table 4.35

.The 'F' (8.46) obtained indicates that there is significant difference amng the three groups.

The group wise analysis given in table 4.36 shows that normal group differs significantly from

the two other groups, viz., non-cardiac and cardiac patients.

Table 4.35 Results of ANOVA based on the three group classification on objective temperament

Between Groups

-. 12673.45 8.46**

Total 13104.74

Sum of Squares


Table 4.36 : Comparison of the three groups for objective temperament

Mean Squares

Groups G ~ u ~ ~ - ~ ~ G ~ ~ ~ ~ c P ~ ~ ~

'F' Ratio

I I I 'Significant at 0.05 level

-100-

For a detailed analysis, the total sample is divided into ten subgroups based on the disease

symptoms and the 'F' ratio (3.66) has been obtained (table 4.37). This also shows thatthere

is significant difference among the different subgroups. Each subgroup is again considered

separately and it is found that the only significant difference exist between ATH and NS. Here

also graph plotted based on thirnean values of different groups and presented as figure 9.

Table 4.37 Results of ANOVA based on the ten group classification on objective temperament

..

Source I DF ( Sumof . S q u a T P k a n Squares / 'F' Ratim

Table 4.38 : Comparison of the ten groups for objective temperament

Between Groups

Within Groups -. .. - ..

Total


0 Objective temperament includes the following characteristics of temperament, realistic

approach, punctuality, systematic dealings, persistence, self-confidence, self-control, self-

analysis, attention, concern about morality and ethics and non-impulsiveness. Based on the

present result it can be stated that normal with the highest mean score of 40.02 differ

significantly from nowcardiac patients (M=37.28) and cardiac patients (M=36.91). This

means that normal is more objective than the other two groups. Here it is worth mentioning

. ~~

~ ~ ~ ~- "Significant a at 0.01 level

9

. - 490

499

825.32

12279.42 ~- . . -- -

13104.74

~ ~ . . . .~

91.70 ~~

25.06 3.66"'

- -101-

that non-cardiac patient and cardiac patients have some physical ~lrnei&~hich&ts their -, /' '. ..-

cognitive functiiing. This may be reason for their lack of objective interpretation O F ~ ~ '

realities around them.

Since the 'F' ratio obtained for tbe ten-group classification is 3.66 here too, the groups differ

-* . significantly. Further detailed analysis shows that only normal (NS) and ATH groups show

significant difference. The least mean score obtained for the ATH (M=34.70) group indicate

that they are weak in thinking and interpreting realistically and reasonably. From the above

result it can be summarised that normal group are more objective in their interpretation of the

world and are more realistic and reasonable in their thoughts when compared to other

groups.

4.2-10 Sociable Temperament

The 'F' raCos for difference between means on sociable temperament with respect to the

C three groups are summarised in table 4.39. The results show that there is no significant

difference among the three groups, viz., normal, non-cardiac patients and cardiac patientson

sociability. The mean values of the three groups are presented in table 4.40.

Table 4.39 Results of ANOVA based on the three-group classification on sociable temperament

Source DF Sum of Squares 'F' Ratio

P. Table 4.40 : Comparison of the three groups for sociable temperament

Mean (SD) G l o w I Group 148 7 Gmup2-NCP 1 GmupMP (

- 102-

Contradictory to the above findings, the 'F' value obtained for the ten-group classification is

significant at 0.01 level. To be more specific the multiple range analysis also has been

carried out and the results are given in table 4.42. The results show that the PE group differs

significantly from four of the subgroups namely NS, MI, ARR and EH. Based on the mean

values of the sociable temperament, a graph is presented as figure 10.

Table 4.41 Results of ANOVA based on the ten group classification on sociable temperament

Table 4.42 : Comparison of the ten groups for sociable temperament

36.70 (9.62) PE (10) -.

39.16 (4.13) ATH(8) ~~

39.30 (3.62) NCP (2)

39.48 (4.99) AN (4) -

39.50 (3.20) EN (9)

--

40.62 (3.99) MI (3)

40.62 (4.68) NS (1) '

-

'Significantat 0.05 level

The variable sociability is the ability of an individual to adapt his behaviour to the changing

social environment and its demands. This variable measures characteristics such as social

activeness, having many friends, enthusiasm, liveliness, pleasantness, "happy go lucky"

attitude, positive responses to criticism, helpfulness and being energetic. In the present

investigation, no significant differences among the nornlal, noncardiac patients and cardiac

patients was found. On the other hand, result of the ten-group classification show that there is

significant difference on the various sub groups. Detailed analysis based on the above result

( S o u r c e ~ ~ / < f ~ ~ s I Mean Squares 'F' Ratio

-104- show that PE group differ significantly from NS, MI, ARR and EH. The higher mean score

obtained for the four sub groups, viz., NS (M=40.62), MI (M=40.62), ARR (M=40.90) and EH

(M=41.64) indicates that they exhibits gregarious types of behaviour and are able to adaptto

the changes in the social environment. The least mean score for the PE (M=36.70) group

shows that they are socially inactive, have limited friends and are not energetic. Even thowh

there is no significant difference among the three groups (normal, non-cardiac patients and

cardiac patients), the ten group classification shows notable differences among the various

sub groups especially between PE and NS, MI, ARR and EH.

Thus the results obtained for the three subscales of the generalised '7 scale show that there

are significant differences between normal, non-cardiac patients and cardiac patients on

stability and objectivity. There is no significant difference among the groups on sociability.

4.2.1 1 Self-esteem

Analysis of variance is done in order to find out whether a difference among the means for

the three groups for the variable self-esteem is significant. The 'F' ratio is found to be

significant at 0.01 level (table 4.43). In order to find out the groups, which are significant,

further analysis is done and presented in table 4.44. Here the result point out that normal

differs significantly from noncardiac patients and cardiac patients.

Table 4.43:Results of ANOVA based on the three group classification on self-esteem

I Source I DF I sumof squares I Maan Squares I 'F' Ratio I 1 n G u i 7 1 1 . 1 5 1 g 1 Within Groups

.- 44571.05 8.93" Total 499 46177 711


Table 4.44: Comparison of the three groups for self-esteem

Mean (SD)

1 69.34(8.22) 1 Gmupl-NS

- Groups


.

Gmup2- NCP

e

GmupS CP Gmupl-NS

-105- The 'F' ratio based on the ten-group classification is also significant at 0.01 level and is

presented in table 4.45. Detailed analysis of the ten groups given in table 4.46 shows that

normal differs significantly from ATH and PE group. While considering the mean values of

other sub groups, there are differences but no significance. Graph based on the mean values

was presented in figure 11

Table 4.45 Results of ANOVA based on the ten-group classification on self-esteem

I Source 1 DF 1 Sumof Squares I 'F(RUO 1 ~ ~-~

Total i 499 j , 4617220 ~ ~ ~ - ~ p ~- ~~p ~~ ~ ~ ~~ .~


Table 4.46 : Comparison of the ten groups for self-esteem

Mean (SD) I Groups PE NCP ARR EH MI EN AN CS NS

(10) (2) (7) (6) (3) (9) (4) (5) (1) 60.38 (12.28) ATH (8)

60.78 (9.50) i PE (10)

61.76 (8.56) NCP (2)

63.20 (6.98) ARR (7)

64.30 (9.49) EH (6)

65.62 (9.25) MI (3)

66.50 (12.25) CS (5) - -- 69.34 (8.22) NS ( I ) '


Self-esteem is believed to be the core concept in the dynamics of a healthy personality. It

signifies a positive or negative orientation towards an object. A person with a high self-

esteem has self-respect and considers himself a person of worth. Appreciating his own

merits, he nonetheless recognises his faults, which he hopes to overcome (Rosen Berg,

1979). The results obtained for the present study based on the three-group classification

indicates that normal persons have high self-esteem, when compared to noncardiac patients

-107- and cardiac patients. The mean values of the three groups, viz., non-cardiac patient

(M=61.76), cardiac patients (M=64.12) and normal (M=69.34) indicate that non-cardiac

patients have the lowest and normal have the highest self esteem score.

The detailed analysis based onthe ten sub groups also supports the above findings, with

significant differences between normal and ATH and PE groups. According to Pierlin and

Schader (1978) high levelsof self-acceptance and self-respect are important contribubrsto

a positive mental state of health. He also pointed out that persons with high self-esteem are

more likely to express high satisfaction with their life and helps the individual cope with

stress. This supports the findings of the present study, ie; the normal scored high on self-

esteem than the non-cardiac patient and cardiac patient groups.

Haltky et al (1986), Amity et al (1989) and Maclend and Haink (1989), through their study

shows that after myocardial infarction (MI) disabled persons were more depressed and had

lower self-esteem score. In the present study, all the subgroups of cardiac patients,

especially the MI group, have lower scores than normal. Thus, it is evidently clear that the

non-cardiac patient and cardiac patient group have lower self-esteem than normal. It can be

concluded that high levels of self-esteem are a contributory factor to a positive mental health

status.

4.2.12 State-Anxiety

The result of ANOVA obtained for the three-group classification on statedimension of anxiety

is significant at 0.01 level (table 4.47). Further analysis is attempted using multiple range

technique and it is seen that normal diiered signifintly from cardiac patients and non-

cardiac patients group. The results are summarised in table 4.48.

Table 447:Results of ANOVA based on the threegroup classification on state anxiety -

(&- J-DF I Sum of Squares 1 b a n Squam 'F' Ratio

I-I-- I

S i i n k n t a t 0.01 level

-

Between Gmup

Within Gmup

Total

- - --

2

497

499

-

309.74 - 8231.74 - 8541.48

-

154.87

16.56 9.35"

Table 4.48: Comparison of the three groups for state anxiety

MunlSD)- -- Groups p u p l - N S 1 Group 3-CP Group 2-NCP

--. -


Based on an analysis of the ten groups the 'F' ratio was found to be 8.12, which is significant

at 0.01 level and presented in table 4.49. The detailed analysis of the ten-group classification

is done using multiple range analysis, and given in table 4.50. This shows that CS and NS

differ significantly from the ATH, ARR and PE groups. In addition to this PE groups differ

significantly from MI group also. Based on the mean values of ten different group studied, a

graph is plotted and presented as figure 12.

Table 4.50: Comparison of the ten groups for state anxiety

Table 4.49 Results of ANOVA based on the ten-group classification on state anxiety

-.

Mean (SD) Groups CS

-- -. - --- 16.52 (4.20) CS (5)

16.56 (3.18) NS(1)

17.60 (3.41) MI (3)

18.52 (3.23) AN(4)

18.66 (3.50) EH (6)

19.56 (5.88) EN (9)

19.64 (3.77) NCP(2)

20.26 (4.75) ATH (8) -

20.34 (3.77) ARR (I)

20.96 (2.02) PE(10) -


Source Sum of Squares

11 08.38 7433.10

Total ~ 499 - - 8541.48 "significant at 0.01 level

Mean Squares

123.15 15.17

pp

~.

'F' Ratio

8.12"

-110- Stateanxiety is defined as a transitory emotional reaction that consists of feelingsof tension,

apprehension, nervousness and wony, and activation of the autonomic rims system. Here

the results show that the cardiac (M=19.05) and non-cardiac patient (M-19.64) groups differ

significantly from normal (M=16.56) in state anxiety. This means that the feelings of tension,

apprehension, nervousness and worry are more among non-cardiac patient and cardiac

patients than among normal group. This may be attributed to their disease condition.

The detailed analysis based on the ten groups also shows that there is significant difference

between the various groups under study. Among the different cardiac patient groups, ATH,

ARR and PE groups have the highest mean values and they differ significantly from the CS

group and normal. The PE group differs significantly from MI group also. Here, the MI

(M=17.60) group score a lower mean value than the PE group. This is contradictory to the

general concept that the most common reactions of MI are anxiety, hopefulness,

helplessness or a mixture of these.

*

Studies by Walih et al(1988) and Affleck et al ( I 987) found that a high and prolcqed level of

state anxiety may be taken as an indicator of a less than optimal cognitive responses to the

stressful event, a response which will itself inhibit adaptive changes over time. A perusal of

the mean values obtained by different subgroups reveals that the cardiac survey group have

the lowest mean score (16.52) followed by normal (M=16.56) and MI (M=17.60). The higher

scores obtained by ATH (M=20.26), ARR (M=20.34) and PE (M=20.96). The mncardiac

patient group comes very close to the above three with a mean score of 19.64. The lowst

score for the CS group is due to the fact that they are aware of their disease and are able to

cope up with Vie conditions associated with the diseases. Thus, it can be concluded that the - normal differs significantly from cardiac as well as mn-cardiac patients.

4.2.13 Trait Anxiety

Table 4.51 shows the details of ANOVA for the three-group classification on trait miety. The

'F' ratio obtained is 11.98, which is significant atO.O1 level. The multi ple rangeanalysisofthe

-111-

three groups show that normal differs significantly from cardiac patients and non-cardiac

patient groups,

Table 4.51 Results of ANOVA based on the three group classification on trait anxiety -. -- -

DF I ~umofsquarn i Mean Squares

Between Gmups

Wiin Groups ~~~h~~ Total

-- .- 7775.03

"Sgnificant at 0.01 level

Table 4.52: Comparison of the three groups for trait anxiety

1 Mean (SD) Groups Gmup I-NS 1 Gmup 3-CP 1 Gmup2-NCP 1 I

.- 'Significant at 0.05 level

The tengroup classification also shows significant differences among various sub groups,

which is shown in table 4.53. The detailed analysis of the said classification using Scheffe's

procedure clearly indicates the specific groups, viz., ARR, NCP, PE and ATH groups which

differ significantly from the normal. In addition to this, the CS group differs significantly from

the ATH group. Graph presented in figure 13 shows the mean valuesof the different groups.

Table 4.53 Results of ANOVA based on the ten-group classification on trait anxiety

/ ~ r < m O f s q U m 1 Mean Squares 'F' Ratio

-1 13-


Trait anxiety refers to relatively stable individual differences in anxiety proneness, i.e; the

differences between people who tend to perceive stressful situation as dangerous and

threatening, and respond to such situation with elevation in the intensity of anxiety. The

results of the three groups presented in tables 4.51 and 4.52 shows that normal have less

trait anxiety when compared to the cardiac patients and noncardiac patient groups. This may

be attributed to the unhealthy conditions of the two groups.

A table 4.53 and 4.54 gives a clear picture of the results of ten-group of sample on trait

anxiety. Here the 'F' ratio is significant, which indicates a clear difference among the various

subgroups, viz., ARR, NCP, PE and ATH with normal. The CS group also differs significantly

from the ATH group. Spielberger et al(1970) found that those who are high in trait anxiety

tend to perceive a greater range of events as dangerotls or threatening and on the basis of

their past experience tend to rate their coping resources negatively. Results of the present

,. study also support the above fmdings. In general, the above results show that cardiac

patients and non-cardiac patients have significantly more anxiety than normal.

4.2.14 State Curiosity

Summary of analysis of variance for the variable state curiosity based on the threegroup

classification is presented in table 4.55. It may be seen that the 'F' ratio obtained was 2.62,

which is not significant.

-1 14- Table 4.55 Results of ANOVA based on the three-group classification on state curiosity

Mean Squares 'F' Ratio

Between Groups 53.86 26.93 Within Groups 5142.50 -- --

p--~~~ ~ ~p - 10.29

- - - 2.62 Total 4 9 9 1 5166.36

The details of the results of ANOVA for differences among mean scores on state curiosity,

with respect to the ten-group classification are shown in table 4.57. The obtained 'F' ratio was

8.27 and is significant at 0.01 level. Multiple range analysis has been carried out to find out

the specific groups, which differ significantly. Based on the mean values of the ten group, a

graph plotted and presented in figure 14.

Table 4.56: Comparison of the three groups for state curiosity

Table 4.57 Results of ANOVA based on the ten-group classification on state curiosity

Groups Group I-NS -

-- -

I F / % o f ~ q u a r e s I Mean Squares 'F' Ratio 1 ;heen~roups-- Within Groups

Group PCP


Group 2-NCP

Table 4.58: comparison of the ten groups for state curiosity

-116-

State curiosity means the transitory desire or inclination to know or learn about anything,

ranging from what is novel or strange to desirous of knowing what one has no right to know.

Some of the facts are carefulness, inquisitiveness, desire to know, studiousness,

concernedness, solicitousness, mental activity etc. From the above description we can see

that low scores indicate less feelings of curiosity, less desire to know something novel, less

inquisitiveness and less prying. The higher scores are desirous of learning or knowing to look for what is new or unusual and to gratify the mind with new discoveries.

As the 'F' ratio obtained for the threegroup classification is not significant and it is clear that

the three groups, viz., normal, mn-cardiac patients and cardiac patients do not differ

significantly in state curiosity.

While considering the analysis of ten-group classification, the 'F' ratio is found to be

significant at 0.01 level. This indicates that the subgroups differ significantly among

themselves. In order to make it more specific the multiple range analysis has also been

carried out (table 4.58). Among the different cardiac patient groups the MI and ARR gmup

differ significantly from EH, CS and normal. Apart from this the ARR groupdiffer significantly

from ATH, AN and PE groups. The highest scores are for the ARR (M=22.26) group and this

may be atbibuted to the irregular heartbeat, in which the heart's contractions are no longer

synchronised properly. Similarly the MI group scored a mean value of 21.26 which is also

due to the sudden onset of chest pain and associated symptoms.

From the above discussion, it can be concluded that, eventhough normal, noncardiac

patients and cardiac patients do not differ significantly, the MI and ARR group of patients

shows significant difference from some of the cardiac patient groups and normal group.

4.2.14 Trait Curiosity

With respect to the variable trait curiosity, the results of analysis of variance based on the

threegroup classification are presented in table 4.59. The 'F' ratio obtained was 5.53 and it is

significant at 0.01 level. Further analysis using the multiple range shows that the normal

group differs significantly from the cardiac patient group.

-117-

Table 4.59:Results of ANOVA based on the three-group classification on trait curiosity ~ ~ - - ~ ~ .--, ~ ~- I source ' I L% 1 Sumof Squares Mean Squares rp'F'R%l

Between Groups -. 129.42 64.71 5.53"

Total 5942.20 "Sianificant at 0.01 level

Table 4.60: Comparison of the three groups for trait curios&

Group I-NS I ~rou~2-/

1 18.20 13.451 ( Grou~ I-NS I I I I

19.88 (3.51) Group 3-CP 1 l--~ ~~ -~ -~ 1 .. I 'Significant at 0.05 level

Analysis based on the ten-group classification shows that the obtained 'F' ratio is

significant at 0.01 level. Further analysis shows that the subgroups of cardiac patients,

viz., ARR, MI, EN and EH differs significantly from CS, NS and PE groups respectively.

Graph presented in figure 15 shows a comparison of mean values.

Table 4.61:Results of ANOVA based on the ten-group classification on trait curiosity

1 Source I DF I Sumof Squares / Mean Squares / 'F' Ratio 1 Between Groups WIhin Gmups 5107.28 8.90** Total -- 5942.20

"Significant at 0.01 level Table 4.62: Comparison of the ten groups for trait curiosity

I Mean (SD) 1 G-CSTNS I PE 1 ATH I NCP 1 AN EH 1 EN I MI 1 ARR I


Trait curiosity refers to relatively stable individual differences in the desire to know or learn

about something novel or strange tc~ desirous of knowing what one has no right to know. The

results given in table 4.60 indicate that there is significant difference between cardiac patient

group and normal. Though the noncardiac patient group vary in mean scores, it is not

significant. The higher mean value of cardiac patients separates them as agroup having high

trait curiosity.

While comparing the scores obtained for the state and trait curiosity it is interesting to riote

that there is hardly any significant difference among the three groups on state curiosity.

However the three groups show significant difference in trait curiosity. The present result

asserts that trait curiosity is high when compared to state curiosity for cardiac patients.

The detailed and specific analysis given in tables 4.61 and 4.62 also Support the above

findings. Among the subgroups of cardiac patients ARR, MI and EN differ significantly from

the CS, NS and PE groups. Another cardiac patient group namely EH differs significantly

from the CS group alone. The high mean scores obtained by these cardiac patient groups are

due to the elevation of blood pressure in the arteries, which aggravates curiosity. When the

results of state and trait curiosity are compared the ARR (M=21.52) and MI (M=21.28) group

have got higher scores in both. The EN group (M=20.96) comes third on mean value in both

state and trait curiosity, but differ significantly with trait curiosity alone. EH group shows a

significant diierence from the cardiac surgery group alone. The CSgroup has a least mean

score of 17.68 on trait curiosity and second least in state curiosity. The cardiac surgery

patients are aware of their physical conditions and the nature of their disease. Moreover in

most of the cases they have been informed about the surgery in advance and thereby aMe to

prepare themselves for the surgery. Hence they are riot much curious aboutthe disease and

thereby the lesser score in this variable.

Based on the above discussion it is clear that cardiac patient group differ significantly from

the normal, on trait curiosity.

-120- 4.2.16 State Anger

The 'F' ratio obtained for the three groups on state anger is presented in table 4.63. Since the

obtained value is significant, a detailed analysis has been done which is presented in table

4.64. This shows that the cardiac patient group differs significantly from normal, in state

anger.

Table 4.64 : Cornparison of the three groups for state anger

Table 4.63 Results of ANOVA based on the three-group classification on State anger

( Mean (SD) 1 Groups 1 Group I-NS 1 Group 3-CP 1 Group2-NCP 1

L 13.18 (3.69) 1 Gmup2-NCP 1 I I I .-

'Signifhnt at 0.05 level

'F' Ratii

3.83"

Between Groups

W i i n Groups 497 4366.24

Total 499 .

4433.48

The d i n t subgroups of the total sample are again analysed and stated in table 4.65. Here

also the 'F' ratio is significant at 0.01 level. A detailed analysis on this respect also has been

done and presented in table 4.66. The results show that CS group differ significantly from

ARR, NCP, MI, EH, EN, ATH and AN group. Inorder to have a clear picture a graph is plotted

and presented in figure 16.


Mean Squares

33.62

8.79

Table 4.65 Results of ANOVA based on the ten-group classification on state anger

Mean Squares 'F' Ratb


Within Groups 7.90 7.88"

"Sinkant at 0.01 level

-122-

Table 4.66: Comparison of the ten groups for state anger

State angerwas defined as an emotional state or conditions that consist of subjective feelings

of irritation, annoyance, fury and rage with concomitant activation or arousal of theautonomic

nervous system. It will vary in intensity and fluctuate over time as a function of injustice on

frustration resulting from the blocking of goal directed behaviour. The result of the present

study makes it clear that cardiac patients have higher score on state anger than normal. The

two groups differ significantly in this particular variable. Researcher in this field has 'pro' and

'anti' findings regarding present result. A study by Mendes-de-Leon (1992) indicates that

particularly overt behavioural expression of anger is related in coronary heart diseases

(CHD). Studies by Denbroski et al(1985), Haynes et al(1980) and MacpDongall et al(1985)

also support the above findings. On the other hand Tennest et al(1987) found a negative

correlation betwleen anger and CHC).

The results presented in table 4.65 and 4.66 shows that there is significant diierence among

the various subgroups. Here the significant difference is only between CS group and AN,

ATH, EN, EH, MI, NCP and ARK gl'oup. This finding is supported by a study conducted on

Angina by Smith et al (1984). He found a positive association between Angina and anger.

Some of the other studies are contradictory to the present result. Study by Follick et al

(1990), found that anger was not significantly associated with arrhythmia.

It is interesting to note that the significant differences exist between CS group and various

subgroups only. There does not exist significant difference between normal and different

subgroups. In contradiction to the general concept, the CS group scores the least in state

anger. Hence, it can be conclupetl that, when the three groups are considered NS t i e r

significantly from cardiac patierit group and on detailed analysis the normal do not differ

significantly from any of the cardiac patient groups.

4.2.17 Trait Anger

The result of ANOVA on trait anger for the three groups is presented in table 4.67. The 'F'

value is found to be significant at 0.01 level. The detailed analysis based on the three-group

classification is given in table 4.68, which shows the normal differs significantly from the now

cardiac patients and cardiac pabent groups.

Table 4.68 : Comparison of the three groups for trait anger

Table 4.67 Results of ANOVA based on the threegroup classification on trait anger --

Source DF -rsurn of squoras &an Squares

Between Groups 171 76

W i i n Groups 9380 10 18 87 ---

Total 499 9723 62

Analysis based on the ten-group classification is presented in table 4.69. This was also found

to be significant at 0.01 level. To make it more specific further analysis is done and p m t e d

in table 4.70. Here the result indicates that CS group differs significantly from the various

subgroups of cardiac patients, except PE group. The normal differs significantly from ARR

and MI. Graph presented in figure 17 shows the comparison of mean values.

'F' ww

9 10"

- -- -- Mean (SD) Groups Group I-NS

-- - --

*Slgnlficant at 0 01 level


Group 2-NCP Group 3-CP

Y

aD Essential H

ypertension

-125-

Table 4.69:Results of ANOVA based on the ten group classification on trait anger

1 OF / sumof ~ q u a n . 1 Mean Squares 1 I F ' Ratio I ; = - 1 -

9723.62 -

""Significant at 0.01 level

The trait anger was defined in terms of individual differences in the frequency of an emomnal

state or condition that consists of subjective feelings of irritation, annoyance, fury and rage

with concomitant activation or arousal of the autonomic nervous system which was

experienced over time. The findings of the present study point out that normal differ

significantly from cardiac patients and non-cardiac patients in trait anger. R is clear from the

result that the psychological variable anger is more prevalent in non-cardiac patients and

cardiac patients than normal and this may be due to the uncomfortable physical conditions

owing to the diseases.

The ten-group analysis indicates that the CS group have the lowest mean score (M=14.94)

and have less trait anger when compared to the other cardiac patient groups except PE. The

normal comes second least with a mean score of 15.76 and differ significantly from ARR

-126- (M=20.28) and MI (M=20.02). Research findings on the relationship between angerand CHD

have produced ambiguous results. The disposition to experiences anger (trait) has been

found to be unrelated to various (;Hi) and points, (Smith et al 1984, Shocken et all985 and

Tennest et al1987) with the exception of a report which suggested positive association with

frequency of angina complaint.

When the state and trait anger is considered it is clear that the normal differ significantly from

cardiac patients. Among the cardiac patient groups, CS group differ significantly from the

other cardiac subgroups except for PE, in both state and trait anger. In the case of trait m r ,

the normal differs significantly from ARR and MI groups.

4.2.18 Depression

The result of ANOVA obtained for the threegroup classification is shown in table 4.71. The

'F' ratio obtained was 7.17 and it is significant at 0.01 level. The detailed analysis shows

(table 4.72) that W normal group differ significantly from non-cardiac patient and cardiac

patient groups.

Table 4.71 Results of ANOVA based on the three group classification on depression

y S O M T [ - ~ u r n of q u a m 1 &an quares 1 'F' Ratio

Wiin Gmups 22790.98 ~ - - ~

7.17"

Total 23448.92 "Significant at 0.01 level

Table 4.72 : Comparison of the three groups ON depression

I Mean (SD) 1 Gmups I GmuplHS 1 Gmup2-NCP I Gmup32P I

'Slgnlfwnt at 0 05 level

The results of ANOVA based on the ten-group classification are presented in table 4.73,

which shows a 'F' ratio of 7.88 and is significant at 0.01 level. The results of multiple analysis

-127-

is given in table 4.74 shows that the ATH and PE groups differ significantly from CS and

normal. Apart from this the ATH group differ significantly from EN group too. Mean values of

the different group were compared and presented in figure 18.

Table 4.73: Results of ANQVA based on the ten-group classification on depression

VI~X-~ 23448.92 "Signifmnt at 0.01 level

y F sum of ~ q u a n 1 Mean Squares


Table 4.74 : Corrlparison of the ten groups for depression

'F' Ratio

329.26

- -

m a n (SD) Groups 1 c S ~ NS EN / AN / ARR / NCP I EH I MI I PE ( ATH /

Depression is generally characterised by loss of interest and pleasure, loss of appetite,

decrease in energy level, sense of worthlessness, difficulty in concentrating and thoughts

about death. Other features that might be experienced by the depressed persons are anxiety,

phobias, over-concern about health, fearfulness and irritability.

As the calculated value of 'F' is significant at 0.01 level, it is revealed that the three groups

differ significantly on depression. The multiple range analysis shows that normal differ

significantly from non-cardiac patient and cardiac patient groups. This is in accordance with

the general concept that the unhealthy condition leads the person to be dejected, dispirited,

discouraged, sad, pessimistic etc.

7.88" W i i n Grou~s 490 41.81

-129- The ten-group analysis also shows significant difference among the various groups. Specific

analysis shows that only ATH and PE group differ significantly from CS, NS and EN.

Friedman and Booth-Keweley (1987) examined the relationship between depression and

atherosclerosis (ATH) and concluded that there is a significant relationship between

depression and ATH. This is in support of the present findings.

The MI group comes close to the PE (Mz.33.64) group with a mean score of 30.64 and it is

not significant. On the other hand several report have underlined the prominence of

depression in the early period of MI (Cay et al1972), Stem et all976 and Stem et al1977).

The studies, which have considered the relationship between depression and hypertension,

have given conflicting findings. Some of the reports found higher rates of depressive

symptoms (Kidson 1973, Thailer et al 1985 and Bulpitt et al 1976) while others fail to do so

(Bontelle e l al 1987, Wheateley et a1 1975, Friendman and Bennetth 1977). The present

study also failed to obtain significant difference between EH and other subgroups, but got a

higher mean score, which revears the presence of depression.

In the case of arrhythmia, no significant difference is obtained from the present study. On the

other hand Kennedy et al(1987) found that depression has been associated with increased

morbidity and mortality in arrhythmia patients. On the whole it can be concluded that

depression is an important psychological correlate in the case of cardiac diseases.

Conclusion

18 variables related to stress and personality were discussed based on the Scheffe

procedure analysis for threegroup and ten subgroup classification. It has been found that

cardiac subgroups have similarities and dissimilarities among themselves. Cardiac

subpmypq show some similarities with normal and NCP subgroup as well. The continuous

physical discomfort, fear of life, irritability and pessimism has made the cardiac patients

emotionally vulnerable. They show several negativecharacteristics like easy susceptibilityto

family stress, social stress, personal stress, lack of objectivity and stability etc. Like avicious

circle these 18 variables affect individuals making them emotionally disturbed and

-130-

aggravating physical ailments, which in turn affects their mental health negatively. Thus these

18 factors are highly relevant to the study of cardiac diseases. They give a picture of weak

points and needs of a cardiac patlent. Treatment should include not only cure forthe physical

symptoms, but also close monitoring of these psychological variables. Forthat purpose, the

degree of intensity of each variable for different cardiac subgroups should be understood and

the reasons for their occurrence should also be known. Moreover patients should be made

aware of the need to develop self-esteem, objective temperament and social temperament

etc that are contributors to a positive mental health status.

1. Family Stress: MI group scored maximum for family stress followed by EH, EN and

AN. Hypertensives are stress sensitive and respond with stronger Mood pressure and

they take longer time to retum to normal. Hypertensives experience normal family

conflicts as highly stressful. The physiological symptoms of these diseases enforce

restrictions and thereby sudden changes in the life of a patient, which creates

unsatisfactory family life and finally family stress.

2. Social Stress: ATH group !scored maximum for social stress. All the other cardiac

disease subgroups got lesser scores than the normal and noncardiac patients. It

must be due to cultural factors like health awareness and environmental conditions

prevailing in Kerala.

3. Personal S m s : Cardiac group experiences more personal stress compared to

normal. This may be due to the constant worries, anxiety, fears and conflict in the life

of cardiac patients. But CS group has a lower score on personal stress because once

the patient undergoes surgery and overcomes the critical stage he seems to be more

confident and becomes free from personal stress.

4. Occupational Stress: EH group scored highest in occupational stress. Essential

hypertension is characterised by sleeplessness, confusion, visual disturbance,

nausea and vomiting, anxiety, palpitation etc. These symptoms naturally affect the

quality of work and performance, which finally leads to occupational stress.

-131-

5. Type A Behaviour: Type! A behaviour does not have much influence on

cardiovascular patients.

6. Extroversion-Introversion: It was found that cardiac patients show more extroverted

traits than the normal a d IqCP groups. Among the cardiac group, EH subgroup

scored maximum followed by MI and ATH.

7. Neuroticism: Emotionally over-responsive individuals are prone to be neurotic.

Emotional disturbances lead to physical complaints like headache, digestive troubles,

insomnia and backaches. PE subgroup had highest score for neuroticism followed by

ATH, ARR and EH subgroups. The disease conditions of these patients make them

very sensitive. Anxiety makes them over respond to situations and in turn they make

neurotic.

8. Stable Temperament The normal subgroup which scored maximum in the Scheffe

test was found to be most stable and PE subgroup scored least. But interestingly ,'

notable differences in stability could be seen only in the threegroup classification and

not in the individual analysis.

9. Objective Temperament The normal group scored highest (M=40.02), which proves

that normals are objective than patient groups. Among the patient groups EN scored

highest (M=37.96) and ATH scored least (M=34.70). This shows that physical

ailments affect objective cognition. The patient group become unrealistic and

unreasonable in their thoughts because of sudden physical changes or continuous

presence of symptoms ot disorder.

10. Sociable Temperament: The three-group comparison does not show any significant

difference between them. In the ten-group classification it was found that EH group

was the most sociable while PE subgroup was least sociable.

11. Self-esteem: The normal people have the maximum self-esteem. People with self-

esteem are highly satisfied with their l ie and thus prepare them to cope up with

stress. In the tengroup analysis, ATH subgroup recorded the least score, followed by

-132-

PE subgroup. The patient group have lesser self-esteem because of the persistence

of physical limitations. This constant awareness makes them to look upon themselves

as incompetent and incapable.

State-Anxiety: The nowcardiac patients and cardiac patients have tendency to

experience state-anxiety In the ten-group classification PE has the highest mean

value (M=20.96) followed by ARR and ATH subgroups. Patients consistently feel

tense, apprehensive and nervous about their health conditions and future. But MI

group scored very less (M=17.60), and very close to normal group (M=16.56) in the

mean scores. This refuses the common concept that MI is accompanied by anxiety

and a conflicting mixture of hopelessness and hopefulness. CS subgroup scored least

(M=16.52) in the ten-group analysis which is again surprising. It may be because they

treat surgery as an end to an ailment and try to cope up with the conditions associated

with their diseases.

. . 13. Trait Anxiety Cardiac and non-cardiac patients have thequalityof &ety proneness

and they consider stressful situations as dangerous and threatening because they

rate their coping resources negatively. ATH recorded highest score followed by PE,

NCP and ARR. In state anxiety also they had the highest scores. Again as in state

anxiety, NS, CS and MI have the least scores though in a different order.

14. State Curiosity. In the ten-group analysis ARR had highest mean value (M=22.26)

followed by MI (M=21.26). Both these diseases have similar symptoms, ARR is

related to electrical conduction systems of the heart while MI is characterised by

sudden onset of chest pain and associated symptoms. It is surprising to observe that

MI, which scored less in state anxiety and trait anxiety and ARR, which had high

scoring in state and trait anxiety are similar in their desire for learning new things.

15. Trait Curiosity Here again, ARR tops the score followed by MI subgroup. EN, M c h

had occupied third position in state curiosity, maintains the same position in trait

curiosity. It can be because the patients of these subgroups are aware of the

- 133-

seriousness of their illness and would like to utilise their available time to imbibe new

things. Cardiac patients as a group have high trait curiosity.

16. State Anger: When threegroup analysis is done, NS was found to be different from

cardiac group, but detailed analysis shows that no significant difference is present.

But cardiac patients as a whole have a higher score than normal in state anger.

17. Trait Anger. TThe normals differ significantly from cardiac patients and NCP. Here

ARR (M=20.28) has maximum score and CS (M=14.94) least. As in state anger, CS

has least score. Normals as a group have lesser scores. The physical discomfort and

mental stress make the cardiac patients prone to anger.

18. Depression: The cardiac and NCP differ from normal on the variable depression.

Over-concern about health leads to fear, irritability and pessimism. Long term

treatments without quick progress make the patients inactive leading to depression. 8

4.3 Results and Discussion on Discriminant Analysis

In many situations a researcher is faced with the necessity to identify the subgroups in a

given sample or to find out the discriminating characteristics among two or more subgroups.

In all these instances the processes involve a clear understanding of the identifying

characteristics of a class or subgroup. In a multivariate set up, this amounts to differentially

weighting the predictor variables and arriving at a composite index which will help in placing a

particular case in a particular category. Discriminant analysis is often the best-suited

technique to achieve this objective. In a general sense, discriminant analysis is a method for

assigning individuals to groups on the basis of information on two or more variables.

Discriminant analysis has been found most useful in applied research. The broad outlineof

the technique is as follows: First, cases are selected whose group membership is already

known. Then on the basis of theory and previous knowledge, those variables which are likely

, to be the most important in discriminating among the groups are identified and measured. A

discriminant analysis is done using these measures, which result in discriminant functions

and centeroids for each group. These functions are used to predict the group membershipof

new cases, whose group memberships are not known. Thus discriminant analysis servestwo

purposes: (1) from among a list of independent variables, identify those which are most

pertinent in discriminating the groups (in which function it is similar to multiple regression

analysis), and (2) produce an equation for predicting group membership of new cases.

For the present study, the discriminant analysis is used mainly for the first purpose, viz., to

identify those psychological variables, which are most discriminative among the different

subgroups, selected for the study. It is expected that the resultswill supplementthe univariate

analysis done for the same purpose in previous sections and will bring out a more realistic

picture in the multivariate set up. The results and discussion based on this is presented in two

sections. Section 4.4.1 deal with the results and discussion of the discriminant analysis

based on the three-group (normal, non-cardiac patients and cardiac patients) classification.

Section 4.4.2 comprises the result and discussion of discriminant analysis based on the ten

group classification, viz., NS, NCP, MI, AN, CS, EH, ARR, ATH, EN and PE.

- 135-

4.3.1 Functions discriminating normal, non-cardiac patients and cardiac patients

The details of the two canonical discriminant function discriminating the normal, non-cardiac

patients and cardiac patients are presented in table 4.75. For reasons of simplicity and

convenience, only the first function is taken into consideration in the present study. The said

table gives the details pertaining to the percentage of variance as 6~5.63%~ canonical

correlation value of 0.45, Wilks Lambda as 0.747 and chi-square values as 142.52, which are highly significant. It is worth noting here that 65.63%of the total variance could be accounted

for by the first function alone.

Table 4.75 Statistical Indicators of Significance of the Discriminant Function 1 Eigen 1 Pct. Of 1 ': 1 Canonical I"$_ "hi- 1 1 Value Variance - Correlation Lambda square

- 0.747 142.52

The result of canonical discriminant function presented in table 4.75 is highly significant.

Therefore it can be said that the present results clearly discriminate the three groups, viz.,

normal, non-cardiac patients and cardiac patients, under study.

Table 4.76 shows the standardised canonical discrimination function coefficients for all the

eighteen variables, when only the first function is retained. This shows the hierarchical order

of importanceof the different variables in the present study. The function coeffcient valued-

0.5306 for the variable social stress indicates that the absence of social stress seems to be

the most important variable in the present study. On the other hand stability with a function

coefficient value of 0.0491 ranked last in the order of importance. Table 4.77gives the details

about the structure matrix, which gives the correlation of each variable with the function. It

may be noted that the variables are arranged on the basis of the magnitude of the correlation

coefficient. Table 4.78 gives the values of canonical discriminant function evaluated at group

means (group centroids).

-136- Table 4.76 Standardised Canonical Discriminant Function Coefficients Table 4.77 Structure Matrix

Variables I Function -7 Social Stress -0.5306

--

Family Stress 0.3843

Extroversion-Introversion 0.3677

Objectivity

Type A Behaviour

Trait Curiosity

Personal Stress -

~evression 1 0.1288

Neuroticism 0.1263

Self Esteem -0.1255 +-- 0.1176

Trait Anger 0.1161

I Sociability 1 -0.0850 1 State Anger -0.0816

State Curiosity 0.0810

0.0784

I Occupational Stress -0.0592 --

Stability 0.0491 -- Sociability -0.0854

Table 4.78 Group Centeroids

Groups

GP. 1 Normal

GP. 2 Non-cardiac patients

GP. 3 Cardiac patients -

Centeroids

-1.1557

-0.5888

0.2181

Table 4.79 Classification of results

Actual Group Predicted Group Membership cases

GP 1 Normal - - - - --

30 (60 %) 10 (20%) 10 (20%) I I I

GP 2 Non-cardiac patients I " I 16 (32%) 1 22 (44%) 1 12 (24%)

GP 3 Cardiac patients 1 400 1 60 (15%) 1 60 (15%) 1 280 (70%)

The classification results based on the function (Predicting group membershipof the subject

based on the function) are presented in table 4.79. The results reveal that 60%of the cases

in normal, 44% of the cases in non-cardiac patients and 70% of the cases in cardiac patients

could be correctly predicted using the function. The overall percentage of cases correctly

classified was 66.4%.

The standardised canonical discriminant function coefficients for all the eighteen variables

are presented in table 4.76 and it shows the hierarchical order of importance of the different

variables in the present study The table indicates that social stress, family stress,

extroversion-introversion, objective temperament, type A behaviour, traitcuriosity, personal

stress, depression and neuroticism are the most important variable discriminating the three

groups. The function coefficient value of -0.5306 for the variable social stress indicates that

absence of social stress is dominating when compared to the other variables. Similarly the

objective temperament variable also obtained a negative score (-0.3307) and thereby

showing the absence of the objective temperament. The other variables, viz., family stress,

extroversion-introversion, type A behaviour, trait curiosity, personal stress, depression and

neuroticism, obtained a positive function coefficient values and thereby representing the

presence of these variables in discriminating the cardiac patients from the normal and non-

cardiac patient groups, when the first function is taken into consideration. It is also observed

that the variables stable temperament, occupational stress, and state anxiety are the least

important variables as far as the present study is concerned.

- 138-

The structure matrix given in table 4.77 shows that the important variable according to the

present analysis is personal stress for discriminating the three-groups, followed by type A

behaviour, family stress, trait anger, objective temperament, and extroversion-introversion

respectively.

These findings clearly support the results that are presented in section 4.2 based on ANOVA

and multiple range for comparing the normal, non-cardiac and cardiac patient groups on all

the variables studied.

The values presented in table 4.79 indicate the prediction of group membership of the

subjects based on the function is highly significant. The sample selected forthe present study

includes normal, non-cardiac patients and different cardiac disease patients. The non-cardiac

patients and cardiac patients are clinically diagnosed by medical professionals and are

undergoing treatment. Based on the scores obtained using psychological inventories on the

said sample, the discriminant function analysis has been done. The results obtained indicate <

that the prediction based on the first function is 66.40% accurate in classifying the three

group of subjects, which have already been diagnosed by medical practitioners. This can be

attributed to the fact that the psychological variables are as important as clinical aspects of

different cardiac diseases. This reflects the importance of psychdogical variables on different

diseases.

4.3.2 Functions discriminating normal, non-cardiac patients and eight different

cardiac patient groups

The present section deals the result and discussion of the discriminant analysis based on the

tengmup classification. The details of the significance of the nine canonical discriminant

functions discriminating the normal, non-cardiac patients and the eight cardiac patient

groups, viz., Myocardial Infarction (MI), Angina (AN), Cardiac Surgery (CS), Essential

Hypertension (EH), Atherosclerosis (ATH), Arrhythmia (ARR), Endocarditis (EN) and

Pericarditis (PE) are presented in table 4.80. For reasons of simplicity and convenience, only

the first function is taken into consideration. Details given in the table includethe percentage

-139- of variance as 34.39, canonical correlation value as 0.6201, Wilk's Lambda as 0.2138 and

chi-square value of 748.13, which are highly significant. Group centeroids, canonical

discriminant functions evaluated at group means, for the ten groups are presented in table

4.81.

Table 4.80 Statistical Indicators of Significance of the Discriminant Function

Table 4.81 Group Centeroids

T G n l T & Value Variance %

Function 1 I Oroup I Function 1

I I

Standardised canonical discriminant function coefficient for all the 18 variables, when only the

first function is retained is presented in table 4.82. The results show that the function

coefficient value of -0.6072 for the variable social stress indicate that the absence of social

stress is dominating while comparing with the other variables. The trait anxiety is in the last

position with a coefficient value of -0.0371. Results presented in table 4.83 gives the details

of the structure matrix, which gives the correlation of each variable with the discriminant

Canonical Correlation

After Fcn

Will.. Lambda

Chi- square

DF

-140-

function pooled over the subgroups. The eighteen variables studied are presented in a

hierarchical order based on its absolute value. The table shows that trait anger (0.4446)

followed by personal stress (0.4239) and trait curiosity (0.4212) have got the highest

correlation coefficient with the function. Similarly, sociability (0.0008), followed by

occupational stress (0.0026) and stability (0.0166) scored the least scores.

Table 4.82 Standardised Canonical Table 4.83 Structure Matrix Discriminant Function Coefficients

Family Stress -- - -

Trait Curiosity -

Personal Stress

~ i i i c t i o n l 1 Variables

1 Stability 1 0.2054 1

Function

I state curiositv ! 0.1466 ! C -- I-I

I Obiectivitv / -0.1097 1

Type A Behaviour t G G G G r + i % i

Trait Anger 0.4446

Personal Stress 0.4239 Trait Curiosity 0.4212 Family Stress 0.3654

State Anger -- 0.3302

-

State Curiosity 1 0.3222

State Anxiety 1 0.2799

Trait Anxiety 1 0.1979 TVIE A Behaviour 1 0.1687

Obiectivitv 1 0.1020 1

Neuroticism

Self-esteem

Stabilitv 1 0.0166 1

0.1570 0.1046

In table 4.84, the classification result based on the predicting of group membership of the

1 Neuroticism - 1 ,;El 1 Trait Anxiety

subjects based on the first functiori is presented. Of the ten-groups studied, only two were

correctly predicted - myocardial infarction with 52% and cardiac surgery with 54% accuracy.

Other cardiac disease groups, except atherosclerosis, were predicted as myocardial

infarction. Atherosclerosis was predicted as cardiac surgery group.

Occupational Stress Sociability

0.0026 0.0008

-141-

Table 4.84 Classification results and predicted group membership

:I ~ A: E: 1 EH 1 ARR 1 ATH EN 1 PE 1 3 1 0 / 8 / 2 / 0

~-

GPIO 50 0 2

The result of discriminant function analysis based on the ten-group classification given in

table 4.82 show that the canonical discriminant function values (first function) are highly

significant. This means that the variables have greater discriminating power when the first

function is taken into consideration

The results of the standardised canonical discriminant function coefficients of the different

variables indicate that the absence of social stress, family stress, trait curiosity, absence of

personal stress, trait anger, absence of occupational stress, extroversion-introversion and

stable temperament are the most important variables in discriminating the different groups

studied. On the other hand trait anxiety, neuroticism and depression are the least scored

variables.

-142-

The presentation of structure matrix based on the magnitude of correlation coefficient in table

4.83 shows that there are differences in the three and ten groupclassification of the sample.

Higher scores obtained in the structure matrix for the ten-group classification are trait anger,

personal stress, trait curiosity, family stress, state anger and state curiosity respectively. The

lower scores obtained in the structure matrix are sociability, occupational stress, stability

objectivity, self-esteem and neuroticism respectively. In the case of lower scores, the three-

group and ten-group classification obtained similar results, especidly sociability, occupational

stress and stability. This result also supports the findings based on ANOVA and Multiple

range analysis presented in section 4.2.

The classification results of the predicted group membership based on the first function

indicate that the myocardial infarction group and cardiac surgery group has been predicted

correctly. It can be attributed thatthe clinical and psychological diagnosis of the said groups

is same and hence the importance of psychological aspects. All the cardiac patient groups,

except atherosclerosis, predicted as the myocardial Infarction group. On the other hand

atherosclerosis, normal and non-cardiac patient groups are predicted in thecardiac surgery

group. The findings indicate that the psychological correlates of different cardiac disease

patients are showing a similar trend irrespective of their medical diagnosis. It can be

attributed that the prediction of group membership based on the different psychological

variables can be made to the myocardial infarction and the cardiac surgery group.

From the results of discriminant function analysis (function I) based on the threegroup and

tengroup classification, it can be concluded that the psychological variables have got equal

importance to predict the disease groups. While considering the three groups, viz., normal,

non-cardiac patients and cardiac patients, personal stress, type A behaviour, family stress,

trait anger, objectivity and extroversionintroversion are the most prominent variables in

discriminating the groups. On the other hand discriminant analysis of the ten groups shows

that these groups are predicted in two sections. Except atherosclerosis, all the other groups

were predicted as Myocardial Infarction and hence show the similarity of the psychological

symptoms among these groups.

-143-

Conclusion

When the medically diagnosed cardiac disease patients, non-cardiac patients and the

normals were subjected to assessment using the inventories and tools developed for this

study, a 66.40% accurate prediction could be made. 6G% of the normals, 44% of the NCP,

70% of the cardiac patients could be predicted.

The absence of social stress and objective temperament and the presence of family stress,

extroversion-introversion, type A behaviour, trait curiosity, personal stress, depression and

neuroticism are the most important factors which discriminate cardiac group from noncardiac

and normal group. When the sample group is divided into ten subgroups, the variables that

discriminate the cardiac subgroups are absence of social stress, personal stress and

occupational stress and presence of family stress, trait curiosity and trait anger. The absence

of social stress and presence of family stress and trait curiosity are relevant to threegroup

and ten-group classification. In the same way, the structure matrix based on themagnitudeof

correlation coefficient for the three-group and ten subgroup classification show similarity. In

the threegroup analysis personal stress, type A behaviour, family stress, trait anger,

objectivity and extroversion-introversion top the list while in the ten subgroup analysis trait

anger, personal stress, trait curiosity, family stress, state anger and state curiosity tap the list

Personal stress, family stress and trait anger have found a place in the first six pit ionsfor

both.

The ten-subgroup prediction could not be done correctly or as accurately as the three-group

prediction because cardiac patient groups show similar psychological trends inspite of

specific physical medical diagnosis. .

4.4 Comparison of cardiac group with non-cardiac and normals based

on their mean values on all variables.

Apart from the above-discussed analysis, an attempt has been made to compare the

mean values of all the variables studied. For this, normal group (NS) and non-cardiac

group (NCP) are compared separately with the different cardiac disease groups. The

results are presented in graphs for a clear understanding. Results of which are

presented separately for the cardiac groups. The objective of the present section is to

highlight the importance of the variables based on the disease categories. This will give

a clear understanding of the different psychological aspects of the diseases. Ninegraphs

have been plotted, of which the normal and the non-cardiac groups are common in all

the graphs, and has been compared with the different cardiac groups. As a preliminaly

step cardiac patients are taken in asingle group and compared with the normal and non-

cardiac group, and presented first. This was followed by the results of the different

cardiac groups.

4.4.1 Cardiac Patients

The graph presented as figure 19 indicates that the cardiac patient group (N=400)

obtained higher score than the normal and non-cardiac group in nine out of the eighteen

variables studied. They are family stress, personal stress, type A behaviour,

extroversion-introversion, neuroticism, trait anxiety, state anger, trait anger and

depression. On the other hand lower scores have been reported in comparison with the

normal and non-cardiac group on four variables, viz., social stress, objective

temperament, state curiosity and trait curiosity. It is interesting to highlight the positions

of the self-esteem, extroversion-introversion and temperament variables. Higher scores

have been obtained by the normal and the cardiac patients placed in the second

position, followed by the non-cardiac group. It can be concluded that higher scores in

family stress, personal stress, type A behaviour, extroversion-introversion, neuroticism,

-146- trait anxiety, state anger, trait anger and depression are the important variables to

predict an individual to have the tendency of cardiovascular diseases.

4.4.2 Myocardial Infarction

.. Since the study comprises eight different cardiac disease groups, a comparison of each

group with the normal and non-cardiac group was also made and presented here. The

graph (figure 20) indicates that the MI group obtained a considerably higher score in

family stress and personal stress. Higher scores were obtained for the variables

occupational stress, type A behaviour, extroversion-introversion, trait anxiety, state and

trait anger and depression, when compared with the normal and non-cardiac groups. A

lower score has been reported for the variables social stress and state and trait curiosity.

Regarding the variable neuroticism and state anxiety, the cardiac group was placed

second, after the non-cardiac group. For self-esteem and temperament variables the

cardiac patient scored higher than that of the non-cardiac group. It can be concluded that

from among the psychological variables, family stress, personal stress, occupational

stress, type A behaviour, extroversion-introversion, trait anxiety, state and trait anger and

depression are the important variables as far as the MI group is concerned.

4.4.3 Angina

The mean values of the different variables of angina patients when compared to the

normal and non-cardiac group, presented in figure 21, indicate higher scores in family

stress, personal stress, type A behaviour, extroversion-introversion, trait curiosity and

trait anger. Angina group scored low only in neuroticism and social stress, when .. compared to the normal and noncardiac group. It is seen from the graph that the non-

cardiac group dominating in occupational stress, state and trait anxiety, state curiosity,

state anger and depression, than the angina patients. Hence it can be concluded that a

higher score in family and personal stress, type A behaviour, extroversion-introversion,

trait curiosity and trait anger and a low score in neuroticism and social stress are the

best predictor variables for the angina patients.

-149- 4.4.4 Cardiac Surgery

The graph presented in figure 22 based on the mean values of the different variables of

cardiac surgery group shows that there are not many differences among the three

groups. Slightly lesser scores have been obtained, in the family, social and personal

stress, state and trait curiosity, state and trait anger and depression by the cardiac

surgery group than the normal and non-cardiac group. As noted earlier, the cardiac

surgery group is also placed second after the normal group in all the three temperament,

self-esteem and the extroversion-introversion variables. It can be concluded here that

the present analysis is not sufficient to discriminate the cardiac surgery patient from the

normal and non-cardiac group. In the present study all the cardiac surgery patients were

put in a single group irrespective of the reasonlpurpose for the surgery. Hence the

difficulties in differentiating the cardiac surgery group from the other two.

4.4.5. Essential Hypertension

It is observed from the graph (figure 23) that the essential hypertension group scored

high in family stress, personal stress, occupational stress, type A behaviour,

extroversion-introversion, neuroticism, sociable temperament, trait curiosity, trait anger

and depression than the normal and non-cardiac group. The least scores were in social

stress and state curiosity. At the same time essential hypertension group obtained low

scores than the non-cardiac group alone in state and trait anxiety and state anger.

Similarly with normal group alone, low scores obtained in stable and objective

temperament and self-esteem. It can be assumed that a higher scores in the variables

family stress, personal stress, occupational stress, type A behaviour, neuroticism,

sociable temperament, trait curiosity, trait anger and depression may be correlated with

essential hypertension.

4.4.6. Arrhythmia

The mean values of different variables of arrhythmia group has been compared and

presented in graph on figure 24. The graph indicates that the arrhythmia group scored

-152- higher than that of the normal and non-cardiac group in the variables personal stress,

type A behaviour, extroversion-introversion, neuroticism, sociable temperament, state

and trait anxiety, state and trait curiosity, trait anger and depression. In the case of family

stress and social stress, the arrhythmia group obtained a lesser mean value than the

normal and non-cardiac group. In occupational stress and state anger, the non-cardiac

group obtained higher scores and was followed by the arrhythmia group and then the

normal group. Regarding stable and objective temperaments and seresteem, normal

groups with highest mean values was followed by the arrhythmia and noncardiac group.

Higher scores on personal stress, neuroticism, state and trait curiosity, and trait anger

and lower scores on family stress, and social stress, than the normal and non-cardiac

group become the best predictor variables for the armythmia group.

4.4.7. Atherosclerosis

The graph plotted as fgure 25 indicates that the atherosclerosis group obtained higher

mean values than the normal and noncardiac group in eleven out of eighteen variables

studied. They are family, social, personal and occupational stress, type A behaviour,

extroversion-introversion, neuroticism, state and trait anxiety, trait anger and depression.

A lower score obtained by the atherosclerosis group than the normal and noncardiac

group in stable, objective and sociable temperament and self-esteem variables. In the

case of state and trait curiosity there is not much difference in the mean values of the

three groups. The non-cardiac group scared highest in the case of state anger, followed

by the atherosclerosis group and then the normal group. The result indicates that a

higher score in family, social, personal and occupational stress, type A behaviour,

extroversion-introversion, neuroticism, state and trait anxiety, trait anger and depression

and a lower score in stable, objective and sociable temperament, and sef-esteem

variables are the most important indicators based on the present study.

4.4.8. Endocarditis

The graph presented, based on the mean values of normal, non-cardiac and

endocarditis groups, as in figure 26 indicates that there is not much difference in any of

es 8

- Ta

Aw=

-h

m

M

Cu

iory

-- T

aw

-155-

the variables studied except in family stress, personal stress and occupational stress. In

the above said variables, the endocarditis scored higher than that of the other two

groups. Endocarditis group obtained lower mean values than the other two in social

stress. As seen in the other cardiac groups, here also the normal group scored high in

the three temperament variables and in self-esteem, followed by the endocarditis and

then the non-cardiac group. It can be concluded here that a higher score in family stress,

personal stress and occupational stress and a lower score in social stress can be the

best indicator for predicting endocarditis group.

4.4.9. Pericarditis

The pericarditis group has been compared with the normal and non-cardiac patients on

their mean values of the variables studied. The graph placed as figure 27 indicates that a

higher score was obtained by the pericarditis in personal stress, type A behaviour,

neuroticism, state and trait anxiety and in depression. On the other hand pericarditis

group obtained lower score than the normal and non-cardiac group on social stress,

occupational stress, stable temperament, objective temperament, sociable temperament,

self-esteem and state and trait curiosity. It is interesting to note that, in contrast with the

other cardiac group who scored second, the pericarditis group was placed only third in

the three temperaments and in the self-esteem variables. It can be concluded here that

higher scores in personal stress, type A behaviour, neuroticism, state, trait anxiety, in

depression and low scores in social stress, occupational stress, stable temperament,

objective temperament, sociable temperament, self-esteem and state and trait curiosity

indicates the pericardits group.

Conclusion

The study conducted on 400 sample cardiac patients has become fruitful because the

psychological variables which are not important in discriminating among the subgroups

could be identified. The discriminant analysis conducted on them gave the discriminant

functions and centemids for each group. This helps in predicting the group membership

of new cases.

The most important indicators for predicting each cardiac subgroup have been stated

except for cardiac surgery. In addition to the diagnosis of physical symptoms, a clear

measurement of these psychological variables should also be conducted to enhance the

effciency of treatments. Along with prescription of drugs, counselling the patient to make

him aware of the psychological impact of his physical ailments should also be done.

Even if diagnosis is difficult because the physical symptoms are non evident or remain

subtle, an analysis of psychological variables and its measurement may help the

physician to identify cardiac disease group. Though the prediction of subgroup may not

be accurate in all cases, corrective measures can be taken for improving the morale of

the patient in the light of available data.

Since the interplay of biological and psychological factors in the development of

cardiovascular disorders has been proved, it is high time for practitioners of medicine to

take up a holistic view where the body-mind transition is accepted.

In the medically aware State of Kerala, mortality and morbidity due to cardiovascular

diseases is high. If people are made aware of the psychological factors that might

contribute to the presence of cardiovascular diseases, they can approach doctors at the

right time, before the disorder worsens. The efficiency of treatment can be increased by

a holistic approach where both physical and mental conditions are given importance for

evaluation and treatment.

159- 4.5 RESULTS AND DISCUSSION OF CHI-SQUARE TEST

As mentioned earlier, information regarding a number of socio-demographic variables of the

subjects was collected using a personal data schedule. The data thus obtained were

subjected to analysis using chi-square test. The results obtained are presented in the

following section

4.5.1. Age

Age has a major role in moulding the individuality of any person. Generally, people have

specific behaviour patterns at different age levels. To certain extent, the behaviour of an

individual is influenced by his age. The results of chi-square analysis based on different age

groups are presented below.

Table 4.85 Chi-square value for different age groups

Chi-square

Pearson

Table 4.86:Row Percentage, Observed and Expected Frequency for different age groups

Group

NS

NCP

MI

AN

C S

E H

ARR

ATH

EN

PE

Total (%)

Exp Fmq

"Signif~ntat 0.01 level

.- Value

- 107.14'*

DF

45

7W Count (Oh)

1 (2%)

1 (2%)

6 (12%)

1 (2%)

1 (2%)

4(8%)

2(4%)

2 (4%)

18 (3.6%)

1.8

- -

-30 Cwnt (Oh)

13 (26%)

21 (42%)

1 (2%)

7 (14%) - 9 (18%)

4 (8%)

9 (18%)

5 (10%)

7 (14%)

2 (4%)

78 (15.6%)

7.8

- 1

7 0 - 3 9 1 40-49 50-59 Count (Yo)

7 (14%)

8 (16%)

16 (32%)

15 (30%)

7 (14%)

11 (22%)

10 (20%)

12 (24%)

12 (24%)

12 (24%)

110 (22%)

11.0

Count (Oh)

16 (32%)

6 (12%)

2 (4%) - 8 (16%) - 11 (22%)

5 (10%)

13 (26%)

13 (26%)

9 (18%)

9 (18%)

92 (18.4%)

9.2

60-69 Count (46)

2 (4%)

7 (14%)

17 (34%)

8 (1 6%)

7 (14%)

7(14%)

8 (16%)

7 (14%)

9(18%)

10 (20%)

82 (16.4%

8.2

Count (%)

11 (22%)

7 (14%)

8 (16%)

11 (22%)

15 (30%)

19 (38%)

10 (20%)

13 (26%)

1 1 (22%)

15 (30%)

120 (24%)

12.0

160- Total sample is divided into six age groups viz., below 30,30-39,4@49,50-59,60-69 and 70

and above. The chi-square value obtained for the different age groups are 107.14, which is

significant at 0.01 level (table 4.85). When the frequencies and row percentages (table 4.86)

are examined, it is seen that a disproportionately high number of subjects above the age of

40 years are classed under the different cardiac disease categories.

While analysing the results in detail, it is seen that higher numbers of MI patients are in 5359

and 60-69 age group. In the case of AN and EN groups higher number of patients are from

the age group 50-59. A disproportionately higher number CS, EH, and PE group of patients

are in 40-49 age range. Higher observed frequencies have been indicated in the age range

30-39 for the ARR group and, 30-39 and 40-49 for the ATH group.

Thus it can be concluded that age group is highly associated with different cardiac diseases.

The present study also indicates that the 40-49 and 50-59 age groups are at higher risk for

having cardiovascular diseases.

4.5.2 Sex

An important aspect considered while selecting the sample was the difference of gender. Chi-

square analysis has been canied out to find out whether there are any significant differences

among males and females on the occurrence of cardiovascular diseases. Results of chi-

square analysis using group membership and sex of subjects as classificatory variables are

presented in tables 4.87 and 4.88.

Table 4.87: Chi-square value for sex

As the chi-square value is 10.76 (table 4.87), which is not significant, it can be concluded that

there is no sex difference in any of the categories studied. While examining the observed

frequency and row percentage (table 4.88) it is seen that there is not much difference

betwen males and females in any of the sub groups, except for pericarditis.

Value

Pearson 10.76

DF

9

161- Table 4.88: Row Percentage, Observed and Expected Frequency for sex (N=500)

Normal L Groups Female Male

Count (Row %)

Non-cardiac Patients

Row Total (%)

Cardiac Surgery

I I I 25 (50%)

Endocarditis

Pericarditis

Among the different sub groups, the MI and EH groups recorded higher observed frequency

(29 and 30) than the expected frequency of 26.3 in the male population. Similarly, in thecase

of PE group male population is dominating with an observed frequency of 35.

I I I 27 (54%)

I Column Total (%) I 237:;%)

E x d d Freauencv

4.5.3 Religion

25 (50%)

27 (54%)

15 (30%)

To some extent the individual's behaviour is influenced by religion and it may also affecttheir

life style and that may have some impact on the occurrence of cardiovascular diseases. The

50 (100%)

23 (46%)

263 (52.6%)

26.3

chi-square analysis has been carried out based on the patients' religious aspects and the

50 (100%)

23 (46%)

35 (70%)

500 (100%)

details are presented in tables 4.89 and 4.90.

50 (100%)

50 (100%)

Table 4.89 Chi-square value for religion I I I I

ChiSqwre

Pearson -Significant at 0.01 level

Value

49.80"

DF

18

162- Table 4.90: Row percentage Obselved and Expected Frequency for religion

Pericarditis 29 (58%) 6 (12%) 50 (100%)

Column Total 228 (45.6%) 51 (10.2%) 500 (100%)

Expected Frequency 22.8 5.1

The chi-square value of 49.80 obtained for different religious groups in table 4.89 shows that

it is significant at 0.01 level. This indicates that religion is associated with the occurrence of

different cardiac diseases

Table 4.90 shows the expected frequencies, observed frequencies and row percentage

of different religious groups with regard to different cardiac diseases. While analysing

the results in details, it is seen that the patients belonging to Christian community are

having higher observed frequency than the expected frequency in the case of MI, EH,

ARR, ATH, EN, and PE groups. Hindu religious background people are dominating in

their observed frequencies in NS, CS and EH group. Similarly the Muslim community

patients are dominating in their observed frequencies in the case of NCP, MI, and AN

groups.This may be due to the differences in the food habits and life styles of these

three religious groups. However, from the present data, it can be concluded that

religion can be one among the determining factor on the occurrence of different cardiac

diseases

163- 4.5.4 Place of Residence

Considering the importance of the locale of the residence of patients, the subjects for the

present study are taken from rural as well as from urban areas. The chi-square value

obtained for place of residence-is 26.31 (table 4.91), which is significant at 0.01 level. This

shows that there is significant difference in the place of residenceof the subject belonging to

the different sub groups.

Table 4.91 Chi-square value for place of residence

Table 4.92: Row Percentage, Observed and Expected Frequency for place of residence

DF

9

Chi-square

Pearson

. . Count (Row %) I Count(Row%) I

"Significant at 0.01 level.

Value

26.31"

50 (100.0) 1 Normal 1 14 (28.0) 1 36 (72.0) 1 Non-cardiic Patiints 30 (60.0) 20 (40.0) 50 (100.0)

Myocardial Infarction 37 (74.0) 13 (26 .O) 50 (100.0)

Row Total (%) G m u ~ s

1 ;2;%:; 1 22 (44.0) 1 50 (100.0) 1 A n

Cardiac Surgery 30 (60.0) 20 (40.0) 50 (100.0)

Essential Hypertension 22 (44.0) 50 (100.0)

Rural Urban

Artherosclerosis

I Pericarditii 1 30 (60.0) 1 20 (40.0) 1 50 (100.0) 1 Endocarditis

30 (60.0)

Table 4.92 gives an account of the observed frequency and percentage of cases in the

different sub groups residing in rural and urban areas. The table shows that people belonging

to rural areas are more in the cardiac and noncardiac patient groups. The results also

33 (66.0)

Column Total (%) 292 (58.4)

29.2 Expected Frequency

20 (40.0) 50 (100.0)

17 (34.0)

208 (41 6)

20.8

50 (100.0)

500 (100.0)

164- indicate that a higher number of patients in the MI, ARR and EN group of patients are residing

in rural areas and the observed frequencies of the said groups are higher than that of the

expected frequencies. On the other hand, the AN and EH group showed a higher

representation of urbanites. Hence it can be concluded that the place of residence of an

individual is also associated with the occurrence of different cardiovascular diseases.

4.5.5 Socio-Economic Status (SES)

Education, occupation and income have been found to be the potential factm influencing the

adjustment and personality characteristics of an individual. To assess the impact of the SES

on different cardiovascular diseases, the chi-square analysis has been carried out and the

results are presented in tables 4.93 and 4.94.

Table 4.93 Chi-square value for socio-ecanomic status (High- Middle Low)

Table 4.94:Row Percentage, Observed and Expected Frequency for socio-economic

Value

Pearsm 21.14

DF

18

status

Nonnal

Non-cadic Patients

Groups

Myocardial Infarction

Angina

Cardiac Surgery

Essential Hypertension

Arrythmias

Atherosclerosis

Endocadis --

SESHigh Count (%I

7 (14%)

10 (20%)

Pericardii

Column Total%

Expected Frequency

Row Total (%)

SESLow Cwnt (%)

20 (40%)

17 (34%)

12 (24%)

8 (1 6%)

11 (22%)

10 (20%)

13 (26%)

SESMedium Count (%)

27 (54%)

23 (46%)

17 (34%)

125(25%)

12.5

20 (40%)

21 (42%)

26 (52%)

28 (56%)

22 (44%)

25 (50%)

27 (54%)

16 (32%)

17 (34%)

20 (40%)

239(47.8%)

23.9

50 (100%)

50 (100%)

10 (20%)

12 (24%)

12 (24%)

14 (28%)

17 (34%)

15 (30%)

10 (20%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

13 (26%)

136(27.2%)

13.6

50 (100%)

500(1W%)

165- Result on different socio-economic status groups (high, middle, low) showthatthe chi-square

value is not significant. The result shows that the low, middle or high sccio-economic status

may not have a direct relationship on the occurrence of diseases.

Eventhough the chi-square value is not significant, the observed and expected frequencies

have been compared and presented in table 4.94.The observed frequencies of MI, AN and

PE group is higher than that of the expected frequencies in the low SES category. The

medium SES categories are dominating in the case of CS, EH and EN in their observed

frequencies. Finally the NS, NCP and ATH groups observed frequencies are higher in

medium and high SES categories. 'The highest observed frequency score is obtained for the

essential hypertension group (28), which justify the general concept that the middle class

people have more problems in life leading to diseases like hypertension, due to their life

conditions.

From the above said results, it can be concluded that, the chances for occurrence of different

cardiac diseases are not directly related to socio-economic status of the people.

4.5.6 Type of family

The type of family is taken as the classificatory variable and the chi-square analysis

has been calculated. The details of which are presented in tables 4.95 and 4.96.

Table 4.95 Chi-square value for type of family

Since the chi-square value of 27.90 is significant at 0.01 level it can be concluded that the

type of family (Joint I Nuclear) is related to the different cardiac diseases. The expected and

observed frequency of the patients who belong to joint family indicates that EH and ARR

group of patients scored higher observed frequencies. This shows that those, who are living

in a joint family set up have more chances to develop hypertension and arrhythmia. On the

other hand, the expected and observed frequencies of the patients who belong to nuclear

Value

27.90"

DF

9 "Sgnificant at 0.01 level

166- family indicates that MI got the highest observed frequency of 46, when compared to the

expected frequency of 40. The present result reveals that the conditions in a nuclear family

system are a contributing factor for the occurrence of myocardial infarction. PE and CS

groups have got observed frequency of 42, which is also higher than the expected one. The

observed frequency of the rest of the groups reported to be very close to that of their

expected frequencies,

Table 4.96: Row Percentage, Observed and Expected Frequency for type of family

Groups Joint Family

Count (%)

Normal

Nuclear Family Count (%)

Non-cardiac Patienb

Row Total

(%I

11 (22%)

Myocardial Infarction I I I

12 (24%)

Angina

39 (78%)

I I I 4 (8%)

11 (22%) 39 (78%) 1 50 (100%)

Cardiac Surgery

50 (100%)

38 (76%)

I I


50 (100%)

46 (92%)

I I I 8 (1 6%)

Arrhythmia

It may be noted from the table that the number of cases with cardiovascular disease are

higher in nuclear families. This of course is a general trend that is prevailing in the modem

urban society, because more people live in the nuclear set up.

50 (100%)

14 (28%)

Column Total (%)

bpeded F l e q ~ n c ~

The findings may be explained on the ground that the present day nuclear families are mostly

tension producing in nature. The heads of these nuclear families have responsibilities of

42 (84%)

36 (72%) ( 50 (100%)

13 (26%)

50 (100%)

100 (20%)

10.0

37 (74%) 50 (100%)

400 (80%)

40.0

500 (100%)

167- different types and they normally do not have anybody to assist them and share these

responsibilities. Added to this, is the competition that is present in the mcdemwrld. Even ifa

person deliberately wants to, he may not be able to escape from the clutches of this evil.

Probably it is the cumulative effects of these strains of life that increases the incidence of

diseases in nuclear families. Hence it can be concluded that the type of family is related to

different cardiac diseases

4.5.7 Family size

The family can be considered a miniature society and the size of the family may intluercethe

adjustments in the family. Hence the chi-square analysis has been canied out and presented

in tables 4.97 and 4.98.

Table 4.97 Chi-square value of family size

Pearson 18.033' 9 I *Significant at 0.05 level

1

Table 4.98 Row Percentage Observed and Expected Frequency for family size

Chi-square

--

Pericarditis 37 (74%)

Column Total (%) 146 (29 2%) 354 (70.8%)

Expected Frequency ---

I I Value DF

168- The results for family size indicate that the chi-square value is significant at 0.05 level. This

means that the size of family is related to the different cardiac diseases. In examining the

expected frequencies and observed frequencies, it can be seen that families with 5 or more

members have more higher observed frequencies than the small family group (4 or below).

Among the eight cardiac subgroups except the CS group all the other groups have more

observed frequencies than the expected frequencies in the case of families with 5 or more

members. In the case of NS and NCP groups the result was on the opposite direction.

In the present day society, where, even the air is filled with the slogan for a small family, even

a very small increase in the number of family members can contribute to significant

differences in the appraisal of life situation. This may be the reason for the observed

significant differences among the groups. It may be the differences in cognitive perception of

the stressful situation, differences n coping mechanisms, and personality differences that

bring about the differences.

4.5.8 Food habits

The food habits of the patients are taken as a classificatory variable and the chi-square

analysis has been carried out, the results of which are presented in tables 4.99 and 4.100.

TaMe 4.99 Chi-square value for food habits

As the chi-square value (29.60) is significant at 0.01 level, it can be stated that there is

significant relationship between food habits and different subgroups. While analysing the

results obtained for the vegetarians I non-vegetarians group of different cardiac patients, non-

cardiac patients and normal groups, it is clear that majority of the patients are non-

vegetarians. The non-vegetarian category is dominating with higher observed frequencies in

the NS, NCP, MI, AN, EH and PE. On the other hand only four out of the ten subgroups, viz.,

CS, ARR, ATH and EN are showing higher observed frequencies in the case of vegetarians.

Value

29.60"

DF

9 "Signifkant at 0.01 h l

169- Table 4.100 Row Percentage, Observed and Expected Frequency for food habits

Groups

Normal



Angina

The results seem to be in agreement with the views prevailing among the public that now

vegetarian food generally is a contradiction to sustained health. Then non-vegetarian diet

high in fat contents has been proved to be a high risk factor for CHD, in that it increases the

cholesterol content of the blood. There has been much investigation into the relationship

between diet and level of blood fats with regard to the production of cardiovascular disease

because of the basic interaction between diet, activity, obesity and blood fats. Hence it rn be

assumed that a diet high in fat content may have lead to cardiovascular disease in the

cardiac group and other illnesses in the nowcardiac group. However it is interesting to note

that 47 out of 50 normals taken for the study have also reported to be nonvegetarians.

Cardiac Surgefy


Arrhythmia

Atherosclerosis

Endocarditis

P e r i c a d i

4.5.9 Smoking Behaviour

Vegetarians Count (%)

3 (6%)

2 (4%)

1 (2%)

2 (4%)

The smoking behaviour of the patients is taken as a classificatory variable md the chi-square

analysis has been computed and presented in tables 4.101 and 4.102.

6 (1 2%)

1 (2%)

7 (14%)

5 (10%)

4 (8%)

1 (2%)

Non-vegetarians Count (%)

47 (94%)

48 (96%)

49 (98%)

48 (96%)

Row Total Count (%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

44 (88%)

49 (98%)

43 (86%)

45 (90%)

46 (92%)

49 (98%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

170- Table 4.101 Chi-square value of smoking behaviour

Table 4.102: Observed and Expected Frequency and Row Percentqe for smoking behaviour

I I I I I I

Chi-square Value

73.43-

DF

27

Normal I 36(72%) 1 8 (16%) 1 1(2%) 1 5 (10%) 1 50(100%) I I I I I


Gmups Non Smokers Cwnt (%)

Noncardiac Patients

I Angina 31 (62%) / 8 (16%) 1 3 (6%) 8 (16%) 50(100%) I I I I


Occasional Cwnt (%)

I I I I I 39 (78%)

Essential Hypertension 1 29 (58%) 1 7 (14%) 1 5 (10%) 1 9 (18%) 1 50(100%) I I I I I

7 (14%) 1 2 (4%) 1 3 (6%) 1 50(100%)

I I I I I 23 (46%) 1 2(4%)

Cardiac Surgery

Frequent Count (%)

9 (18%)

I I I I I 38 (76%)

Anythmias

Athemsclemsis

Pericarditis 1 19 (38%) 1 13(26%) 1 5 (10%) 1 13 (26%) 1 50(100%) I I I I I

Regular Count (%)

Endocarditis

Column Total (%) 1 301 (602%) 1 62 (12.4%) 1 44 (8.8%) 1 83 (18.6%) 1 500(100%) I I I I I

Row Total Count (%)

16 (32%)

1 (2%)

26 (52%)

27 (54%)

50(100%)

I I I I I 33 (66%)

A result on different subgroups of the sample shows that chi-square value is significant at

3 (6%)

4 (8%)

6 (12%)

6 (12%) 1 7 (14%) 1 4 (8%) 1 50(100%)

I Expected Frequency I 30.1

0.01 level. This indicates that smoking habit is associated with the different cardiac diseases.

Smoking behaviours are classified into four categories viz., non-smokers, occasional

8 (16%)

6 (1 2%)

3 (6%)

6 2

smokers, frequent smokers and regular smokers. As seen from the table, majority of the

50(100%)

respondents in all the 10 groups has reported that they do not have the habit of smoking.

14 (28%)

14 (28%)

4.4

While analysing the smoking habits of the rest of the patients it is clear that, irrespective of

50(100%)

50(100%)

9.3

occasional or frequent or regular smokers, the MI, EH, ARR, EN and PE has indicated a

strong link between smoking and the diseases.

4.5.10 Alcohol Use

Alcohol Use of the patients has also been taken as a classificatory variable in the present

study. The result of the chi-square analysis has been presented in tables 4.103 and 4.104.

alcoholic, occasional, frequent and regular alcohol users. Among these, frequent and regular

Table 4.103 Chi-square value for alcohol use

Chi-square

Pearson

"SinifIcant at 0.01 level

Table 4.104:Obsewed & Expected frequency and Row Percentage for alcohol use

Since the chi-square value is significant at 0.01 level, it can be concluded that alcohol

consumption is a determining factor in the occurrence of different cardiac diseases. The

patients are divided into different categories based on their alc~hol consumption, viz., non-

Value

48.59"

DF

27

172- alcohol consuming categories are more prone to different cardiac diseases like MI, EH, ARR

and PE. The observed frequencies of these groups are higher in the case of alcoholic

consumption than that of their expected frequencies.

4.5.11 History of BP I diabetes I other diseases

Table 4.105: Chi-square value for the history of BP I diabetes 1 other diseases

Chi-square

Table 4.106: Observed & Expected Frequency and Row Percentage for the history of BP I diabetes I other disease symptoms

Pearson

N.A Not CIpplkaMe

Value

A detailed analysis of the patients having previous history of blood pressure, diabetes or

DF

"Significant alO.O1 level

1 15.32**

other diseases symptoms, show that the chi-square value is significant of 0.01 level (tables

27

4.105 and 4.106). This means that BP and diabetes are related to the occurrence of different

cardiac diseases. Except MI, and ATH, all the other subgroups of cardiac patients have a

173- previous history of BP. When the diabetes patients are considered, except for CS and EH

groups, there are chances for other cardiac diseases like myocardial infarction, angina,

arrhythmia, atherosclerosis, endocarditis and pericarditis. The history of having both BP and

diabetes also substantiate the above said result.

4.5.12 Hospitalisation

Table 4.107 Chi-square value for the details of hospitalisation

Table 4.108 ObSe~ed &Expected Frequency and Row Percentage of hospitalisation

Value

88.26'

DF

18 "Significant at 0.01 level

Groups

Normal



Angina

Cardiac Surgely

Since the chi-square value is 88.26, the association between different subgroups of cardiac

Not Hospitalised Count (%)

36 (72%)

21 (42%)

30 (60%)

21 (42%)

15 (30%) 1 15 (30%) 1 20 (40%) 1 50 (100%)


Arrythmias

Atherosclerosis

Endocarditis

Pericardii

Column Total (%)

Expected Frequency

patients and history of hospitalisation is highly significant. This shows that there are more

I I I I

chances among the previously hospitalised due to heart diseases, to have cardiac diseases

Cardiac Count (%)

0

5 (10%)

18 (36%)

17 (34%)

N A- Not Applicable

21 (42%)

12 (24%)

13 (26%)

13 (26%)

12 (24%)

194 (38.8%)

19.4

in a later stage, except for cardiac surgery.

Others Count (%)

14 (28%)

24 (48%)

2 (4%)

12 (24%)

16 (32%)

18 (36%)

19 (38%)

23 (46%)

26 (52%)

157 (31 A%)

15.7

Row Total Count (%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

13 (26%)

20 (40%)

18 (36%)

14 (28%)

12 (24%)

149 (29.8%)

14.9

50 (100%)

50 (100%)

50 (100%)

50 (100%)

50 (100%)

500 (100%)

174- Conclusion

The above stated results arid discussion on chi-square analysis for the 12 selected

demographic variables reveals that except socio-economic status and sex, all the other

variables are significantly related to cardiac diseases. Age, religion, place of residence, type

and size of family, food habits, smoking and alcoholic behaviour, previous history of

BPldiabetes and hospitalisation are the variables which are directly linked to cardiac

diseases, which lead to or aggravate cardiac diseases in a person. The following are the

conclusions based on the chi-square analysis of the variables.

1. Age: Persons in the age group of 40 - 59 are more prone to cardiac diseases.

2. Religion: It has been observed that Christians are more prone to MI, EH, ARR, ATH,

EN arid PE whereas Muslims dominate in MI and AN. Observed frequency for Hindu

patients is more in CS and EH group. The food habits and life style of each

community 1 religion might be the cause for particular religions dominating in different

cardiac groups.

3. Place of residence: The numbers of cardiac and noncardiac patients are more in the

rural area. It might be because of lack of health facilities. The observed frequencies of

MI, ARR and EH groups is more than expected frequencies in the case of ruralites.

But urbanites dominate in AN and EH group. It may due to the hectic and stressful life

style of the urbanites.

4. Type of family: There is clear evidence to show that the proportion of incidence of

cardiovascular diseases is greater for nuclear families. This may be because most

urban Keralites live in nuclearfamilies. The variation between observed and expected

frequencies in PE, CS and especially MI groups is more in patients belonging to

nuclear families. The competition experienced by individuals and added

responsibilities of the senior members of a nuclear family may be the supporting

factors that make nuclear family members vulnerable to cardiac diseases.

175- 5. Size of the family: It has been observed that the observed frequency of large family

group exceeds the expected frequency in the 8 cardiac subgroups except CS.

6. Food habits: According to the popular concept, non-vegetarian food high in fat

content has a relation with cardiac diseases. Most cardiac patients taken for study - %

preferred non-vegetarian. The non-vegetarian category dominated with higher

observed frequencies in MI, AN, EH and PE cardiac subgroups, while vegetarians

dominated in CS, ARR, ATH and EN subgroups.

7. Smoking: Patients with OftenlFrequentlRegular smoking habit dominate in their

observed frequencies among the MI, EH, ARR, EN and PE subgroups.

8. Alcdrolism: FrequentlRegular alcoholics dominated in their observed frequencies

among MI, EH, ARR and PE subgroups.

9. History of BPhIiabeWOther diseases: The chances for a BP patient to have

cardiac diseases are high. All cardiac subgroups except MI and ATH were seen to

have BP. Diabetes can cause MI, AN, ARR, EN and PE. Histories of having both BP

and diabetes was seen in AN, ARR, EN and PE.

10. HosjWiSatbn: Patients who have been once hospitalised especially due to heart

diseases have high chances of developing other cardiac disorders.

The chiisquare value was not signifcat for variables, soci~economic status and sex. No

observations which favour the popular belief that males are prone to cardiac diseases could

be made. It may be because the life styles of women havechanged. They have set foot in all

fields where men had dominated.

result discussion - shodhgangashodhganga.inflibnet.ac.in/bitstream/10603/640/12/12_chapter4.pdf ·...

Documents