Mental Health Care in Cardiac Care: A Qualitative Study with Patients, Spouses, and Clinicians

Abstract

Serious Cardiac Illness (SCI) is often correlated with undertreated psychological distress for both patients and their spouses, yet services for mental health needs are consistently undetected, and inadequately addressed across the timeline of cardiac care. This qualitative study was initiated to address the research priorities identified by a Community-Advisory Board (CAB) in the WWAMI region (Washington, Wyoming, Alaska, Montana, Idaho) associated with SCI. This thesis explores key gaps in mental health services that exist across the SCI timeline, why those gaps persist, and invites some creative solutions worth considering. Semi-structured interviews were conducted with CAB members, which include patients, spouses, and clinicians. Interviews were used to collect and analyze the participants' experiences with receiving and providing mental health care at the Heart Institute at University of Washington Medical Center. Four key periods of vulnerability were identified: 1) beginning of admission, 2) during inpatient period, 3) discharging from the hospital, and 4) interim period between follow-up appointments. Participants involved in this project described heightened anxiety, emotional instability, and a sense of being untethered after leaving the hospital. Both patients and spouses reported symptoms of distress due to medically-related post-traumatic stress disorder (PTSD). Post-discharge experiences emerged as a particularly important period where participants receiving care could have utilized more robust mental health services, if available. Two primary barriers for clinicians emerged; limited access to affordable mental health services, and structural constraints within the healthcare system. This study highlights critical gaps in mental health services for SCI populations, and emphasizes the need for accessible care. This work presents creative ways for improving mental health services to SCI populations during key periods of variable vulnerability throughout their care.