Academic journal article Canadian Psychology

Contributions toward Evidence-Based Psychocardiology: A Systematic Review of the Literature

Academic journal article Canadian Psychology

Contributions toward Evidence-Based Psychocardiology: A Systematic Review of the Literature

Article excerpt

JOCHEN JORDAN, BENJAMIN BARDE, and ANDREASMICHAEL ZEIHER (Eds.) Contributions Toward Evidence-based Psychocardiology: A Systematic Review of the Literature American Psychological Association, 2006, 552 pages (ISBN: 9781591473589, US$99.95 Hardcover)

Reviewed by TAVIS S. CAMPBELL

Psychocardiology (often termed "behavioural cardiology" in North America) refers to the study of biopsychosocial factors in the emergence, course, and rehabilitation of cardiac diseases. The diree editors of this text, a psychosomatic researcher, psychoanalyst, and cardiologist, note at the outset that, although research in this area has been extensive, they believe the findings are seldom applied in clinical settings. Thus, their decidedly ambitious goal is to provide reviews that could serve as authoritative sources for the formulation of guidelines by scientific societies and institutions like the World Health Organization (WHO). This process began in 1998 with a "Psychocardiology Status Conference" in Germany during which 32 scientists from five countries met to review the existing literature and draft reviews over the ensuing five years. Unfortunately, this means that although the copyright date, is 2007, the reviews focus largely on research published more than five years earlier, ignoring what are arguably the largest and most influential clinical trials and observational studies in behavioural medicine to date including ENRICHD, SADHEART, and INTERHEART. Reflecting a strong trend in the field towards evidence-based behavioural medicine, 10 systematic reviews of broad areas in psychocardiology are presented based on what the editors describe as "...comprehensive database searches using methodological criteria based on those of evidence-based medicine." The actual criteria adhered to differs across the chapters of the text and vary from none at all to use of the rigorous Cochrane review guidelines. Although this inconsistency requires that the reader become acquainted with a new set of criteria at the beginning of each chapter, descriptions of the review strategies are clear and transparent.

The first chapter provides a comprehensive overview of the sociological aspects of the development and course of coronary heart disease (CHD). For a novice to the field, it provides good coverage of classic studies (e.g., Whitehall) linking socioeconomic status (SES) with health outcomes and considers the variability that is direcdy attributable to SES independent of various health behaviours. A reasonable exploration of some plausible explanatory factors is provided although for some, like the impact on prenatal development, coverage is cursory. Specifically, although it is noted that prenatal development may account for up to one-third of the total variance observed between different social groups, no reference or further information is provided.

In light of a stated commitment to evidence-based reviews and recommendations, it seems puzzling to this reviewer that Chapter 2 (the longest in the text at 46 pages) considers 100 years of psychoanalytic research on the aetiology, course, and psychotherapy of CHD and includes articles "...without regard to their methodological quality." This inconsistency in attitude surrounding the importance of evidencebased research and practice is foreshadowed on page 3 of the Introduction, where the editors write that "...psychological interventions demand patience and time, because they must take into account the patients life history and previous and existing social attachments as well as his or her unconscious conflicts and contradictory motivations," without provision of context or references. Although Chapter 2 does contain several interesting anecdotes and historical quotes from the likes of pioneers like Flanders Dunbar, who conducted research at the New York Presbyterian Hospital over 70 years ago, little of the research reviewed would be considered up to par with the methodological rigour demanded by the field today. …

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