Clinical cut scores for the Persian version of the personality inventory for DSM-5.

BACKGROUND: The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups. METHODS: Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests. RESULTS: All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status. CONCLUSION: Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

Risk Factors and Psychosocial Correlates of Emotionally Negative Dreams in Patients Referred to a Cardiac Rehabilitation Centre.

INTRODUCTION: Dream, as a kind of mental activity, includes various functions such as mood regulation, adjustment and integration of new information with the available memory system. The study was done for assessing the relationship between physiological and psychological components of cardiac diseases with emotionally negative dreams in cardiac rehabilitation. METHODS: At the baseline of this cross-sectional study, 156 patients from Western Iran participated during April-November 2016. People 20 years-80 years able to recall the emotional content of dreams after cardiac surgery entered the study. The Beck depression inventory (BDI), Beck anxiety inventory (BAI), Buss and Perry's aggression questionnaire (BPAQ) and Schredl's dream emotions manual were used for collecting data. A binary logistic regression analysis used for the study of the relationship between risk factors and emotionally negative dreams. RESULTS: The mean age of participants was 59 (SD = 9) years (men: 64.1%). The results showed that 25% of patients have negative emotional content. After adjustment for demographic variables, the results showed that increased anxiety [adjusted odds ratio (adj OR) = 1.08 [1.01-1.16], P = 0.020] and anger (adj OR = 1.03 [1.00-1.06], P = 0.024) and hypertension (adj OR = 2.71 [1.10-6.68], P = 0.030) can predict the dreams with negative content significantly. CONCLUSION: The increasing rates of anxiety and anger and history of hypertension are related to increasing dreams with the negative emotional load. The control of risk factors of dreams with negative emotional load can be the target of future interventions.

The Mediator Role of Aggression in the Relationship between Marital Stress and Depression among Patients with Coronary Artery Disease.

BACKGROUND: Depression is one of the most important consequences of cardiovascular diseases (CVDs), and to control and treat it, it is necessary to identify its direct and indirect triggers and underlying factors. Therefore, the current study aims to evaluate and investigate the mediator role of aggression in the relationship between marital stress and depression. METHODS: The sample of current cross-sectional study includes 212 patients with coronary artery disease (CAD) in Iran evaluated from Jan to Jun 2017. The required data were gathered using Beck's Depression Inventory (BDI) questionnaire, Buss and Perry's Aggression Questionnaire (BPAQ), and Hudson's Marital Satisfaction Index (HMSI). The data were analysed using Pearson's correlation coefficient and structural equation modeling (SEM) using SPSS20 and AMOS software. RESULTS: The mean age of participants (68.4% male) was 58.5 ± 8.9. The results show that there is a significant positive relationship between all the variables (P < 0.05). The results of the model show that marital stress cannot directly predict depression (P = 0.586). However, through aggression, marital stress can significantly predict 18% of the variance of depression (P < 0.001). CONCLUSIONS: Not directly, but indirectly through aggression, marital stress can significantly predict increased depression among patients with CAD. The physiological and psychological pathways of the findings can be discussed.

Applying Behavioural Incentives to Increase Adherence to Maintenance Treatment.

A significant portion of the various communities, especially developing countries, is involved in drug abuse and receive formal drug treatments. Although the benefits of available therapeutics such as methadone maintenance treatment (MMT) for controlling infectious diseases have been confirmed, treatment failure has been seen in a large range of the patients. This review addresses the importance of a less attentive behavioural approach in reducing treatment withdrawal. The executive protocol, the outcomes and challenges, and the benefits of this approach are debatable.

The maladaptive domains according to the alternative model of personality disorders (AMPD) criterion B in patients with affective disorders and temperamental triads related to these domains: two unique profiles.

OBJECTIVES: The study aimed to (i) compare the maladaptive domains and facets according to the Alternative Model of Personality Disorders (AMPD) Criterion B in patients with a type II bipolar disorder (BD-II) or major depressive disorder (MDD) with healthy controls (HCs), and (ii) investigating the relationship between affective temperaments and these domains and facets in the total sample. METHODS: Outpatients diagnosed with current BD-II (n = 37; female 62.2%) or MDD (n = 17; female 82.4%) based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and community HCs (n = 177; female 62.1%) in Kermanshah from July to October 2020 included this case-control study. All participants completed the Personality Inventory for DSM-5 (PID-5), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and the second version of the Beck Depression Inventory (BDI-II). Data were analyzed using analysis of variance (ANOVA), Pearson correlation, and multiple regression. RESULTS: The score of patients with BD-II in all five domains and those with MDD in three domains including negative affectivity, detachment, and disinhibition are significantly higher than the HCs (p < 0.05). Depressive temperament (related to negative affectivity, detachment, and disinhibition) and cyclothymic temperament (related to antagonism and psychoticism) were the most important correlates of the maladaptive domains. CONCLUSIONS: Two unique profiles are proposed, including three domains of negative affectivity, detachment, and disinhibition associated with the depressive temperament for MDD, and two domains of antagonism and psychoticism related to cyclothymic temperament for BD-II.

A Systematic Review of the Instruments Used for Evaluating Causal Beliefs and Perceived Heart Risk Factors.

Background: The etiologies and causal beliefs of heart disease are considered one of the 5 dimensions of health self-regulatory model. Thus, the present study aimed to review the literature and screen the appropriate tools for evaluating the causal beliefs and perceived heart risk factors (PHRFs). Methods: The review samples encompassed all published articles from 1992 to March 2017. A systematic search was conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO, ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the articles was examined using the checklists of the Critical Appraisal Skills Programme (CASP) by 2 independent investigators. After the application of the criteria for inclusion in the study, 22 studies were obtained according to the PRISMA guidelines. Results: A total of 10 504 (50.5% male) patients at an average age of 57.85±10.75 years participated in 22 studies under review. The results of the systematic review showed that 22 tools were available to measure PHRFs. The instruments were categorized into 4 groups of valid scales (6 studies), invalid questionnaires (6 studies), checklists (3 studies), and open-ended single items (7 studies). Only 23.2% of the measuring instruments were sufficiently valid. Conclusion: The results of this systematic review showed that a limited number of valid tools were available to measure PHRFs. Considering the importance of studying cardiac patients' perception of the etiology of disease and the paucity of standards and valid grading scales, it seems necessary to design and provide tools with broader content that can cover all aspects of patients' beliefs.

Comparison of Sexual Knowledge between Patients Prepared for Cardiac Surgery and Patients Prepared for Cardiac Rehabilitation in Iran.

Background: Although sexual death during intercourse occurs rarely in patients with cardiovascular diseases (CVDs), most such patients avoid it because they fear a dangerous event. Given the significance of awareness about this issue among patients with CVDs, we sought to compare sexual knowledge between 2 groups of patients prepared for cardiac surgery and patients prepared for cardiac rehabilitation (CR). Methods: This cross-sectional study, conducted between April and July 2016, recruited 157 patients with CVDs (107 candidates for surgery and 50 patients prepared for CR) in Imam Ali Hospital, in the Iranian city of Kermanshah. The cases, selected through entire counting according to our inclusion criteria, responded to a standard sexual knowledge inventory. Sexual knowledge and professionals responsible in providing sexual rehabilitation from the perspective of patients were compared using the independent t-test and the χ2 test. Results: The participants' mean age was 55.39±9.82 years (male: 58.6%). Overall, the 2 groups had poor sexual knowledge. Although the CR program started 57.85±13.92 days after surgery, the sexual knowledge of this group of patients was not significantly different from that of the patients prepared for surgery (P=0.904). This difference was not significant between the 2 genders (P=0.077). Finally, concerning the professionals responsible in providing sexual rehabilitation, the patients selected psychologists (P=0.006) and nurses (P=0.012) more frequently in the initial phase of CR program. Conclusion: Sexual knowledge was poor in our CR patients at the outset of the program. Given the poor knowledge in these patients 2 months after surgery and the lack of significant difference in knowledge between these patients and those prepared for surgery, it is advisable that they be provided with the necessary information in this regard in this golden time before hospital discharge.

Role of perceived heart risk factors by outpatient population in predicting cardiovascular risk.

Introduction: Regarding the expanding population in developing countries who are at risk for cardiovascular diseases (CVDs), identification and management of effective factors are important in reducing the risk of CVDs. So, the present study aimed to assess the role of perceived heart risk factors (PHRFs) in the prediction of cardiovascular risk among outpatient patients. Methods: The samples of this cross-sectional study included 150 outpatient patients who attend the clinic of Imam Reza hospital during October-December 2016. The participants were completed the Perceived Heart Risk Factors Scale (PHRFS) and Cardiovascular Risk Assessment Questionnaire (CRAQ). Data analyzed through Pearson correlation and multiple regression analyses. Results: Based on the findings, 28%, 40%, 22.7%, and 9.3% of patients were low, medium, high, and severely high-risk, respectively. The strongest predictors of the cardiovascular risk were physiological (ß=-0.273; P=0.004), psychological (ß=0.236; P=0.020), and biological risk factors (ß=0.209; P=0.016), respectively. In addition, the strongest predictor of the lifestyle risk was physiological risk factors (ß=-0.264; P=0.007). Other variables do not play a significant role in predict the lifestyle risk (P>0.05). Our model was able to explain 9.2% of cardiovascular risk variance and 5.7% of cardiovascular risk caused by lifestyle variance. Conclusion: The higher patients' perception about biological and psychological risk factors is concerned as an alarm for increased cardiovascular risk while higher perception about physiological risk factors is associated with reduced cardiovascular risk caused by lifestyle and total cardiovascular risk. The programs reducing cardiovascular risk should target the high-risk groups to save cost and time.

Refractory angina frequencies during 7 weeks treatment by enhanced external counterpulsation in coronary artery disease patients with and without diabetes.

Background: Refractory angina is a clinical diagnosis which implies to chronic pain due to coronary artery insufficiency and it is often resistant to routine cardiac treatment. The present study conducted to compare changes in refractory angina frequencies during 7 weeks treatment by enhanced external counterpulsation (EECP) in coronary artery disease (CAD) patients with and without diabetes. Methods: In this retrospective study, 94 CAD patients (30 diabetics vs. 64 nondiabetics) who referred to cardiac rehabilitation department of Imam Ali Hospital of Kermanshah, Iran, during January 2006-2014 were assessed. The interventional method was EECP and medical records and frequencies of self-reported chest pain were research instruments. Data were analyzed through Chi-square test, mixed repeated measures, and Bonferroni test. Results: Frequencies of pain in both diabetic and nondiabetic groups during 7 weeks had linear reduction, but this reduction was significant only among nondiabetic patients (P < 0.0005). Furthermore, the significant reduction in frequencies of pain among this group begins after the 5th week. Discussion: Diabetes is one of the obstacles to the successful control of pain frequencies by the EECP in patients with CAD. Future studies may pay attention to the confounding role of diabetes in improving the severity of chest pain.

Is enneagram personality system able to predict perceived risk of heart disease and readiness to lifestyle modification?

Background: Studying personality traits and patterns is of significant importance in adopting healthy behaviors. Therefore, the current study investigates the relationship between Enneagram personality types and perceived risk of heart disease and readiness to lifestyle modification. Methods: In this cross-sectional study, 190 noncardiac patients (82.3% female) in an outpatient clinic in western Iran were selected using a simple random sampling method to fill out standard questionnaires. The obtained data were analyzed using Pearson's correlation coefficient and linear regression analysis. Results: The findings show that the performer personality (Type 3) can directly predict increasing readiness to lifestyle modification (P < 0.001). In contrast, there is a reverse significant relationship between the challenger personality (Type 8) and readiness to lifestyle modification (P = 0.019). Moreover, the helper personality (Type 6) is able to directly predict increasing the perceived risk of heart disease (P = 0.012). Conclusions: In the Enneagram system, unique personality types possess a unique risk perception and readiness to adopt healthy behaviors. The results of the current study can provide valuable information for healthy lifestyle programs professionals with regard to preventing cardiovascular diseases.

A Predictive Model of Perceived Susceptibility during the Year before Coronary Artery Bypass Grafting.

Background: Based on the protective health model, one of the most important components of etiological factors leading to protective health behaviors is perceived risk or perceived susceptibility. Accordingly, the present study was conducted to assess the uncontrolled and controlled effects of some factors in predicting perceived susceptibility among coronary artery bypass graft (CABG) patients. Methods: The data for the present cross-sectional study were gathered via assessment of 1052 CABG patients who referred to an outpatient cardiac rehabilitation clinic in a hospital in Iran between 2010 and 2014. The patients completed a checklist containing demographics, risk factors, and a single closed-ended question regarding perceived susceptibility at the beginning of their rehabilitation program. Binary logistic regression analysis was applied to identify the demographic and clinical correlations related to perceived susceptibility. Results: Totally, 776 (73.8%) of the 1052 participants were male. The mean age of the patients was 58.0 ± 9.1 years. The results revealed that only 13.7% of the patients had perceived susceptibility; in addition, higher age (p value = 0.003) and family history of cardiac diseases (p value = 0.001) were able to significantly predict perceived susceptibility. When the demographic variables were controlled, once again age and family history of cardiac diseases were able to significantly increase perceived susceptibility by approximately 1.04 and 29.6 times, respectively. Conclusion: Our results revealed that higher age and family history of cardiac diseases were able to significantly predict perceived susceptibility among our CABG patients.

Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression.

BACKGROUND: The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression. METHODS: In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May-October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis. RESULTS: The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019). CONCLUSION: The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.

Barriers for the referral to outpatient cardiac rehabilitation: A predictive model including actual and perceived risk factors and perceived control.

OBJECTIVE: To assess the roles of demographic factors, actual and perceived risk factors, and perceived control in the referral to cardiac rehabilitation (CR) after coronary artery bypass graft (CABG). METHODS: In this cross-sectional study, data related to 312 CABG patients in a hospital of the Western part of Iran, gathered through demographics and actual risk factors' checklist, open single item of perceived heart risk factors, life stressful events scale, and perceived control questionnaire. Data analyzed by binary logistic regression. RESULTS: The results showed that only 8.3% of CABG patients refer to CR. The facilitators of this referral included official employment (P < 0.05), coronary history (P = 0.016), and hyperlipidemia (P = 0.030) but more distance to the CR center (P = 0.042) and perceived physiological risk factor (P = 0.025) are concerned as the barriers for the referral to CR. CONCLUSION: Providing appropriate awareness about the benefits of CR for patients with regard to their job status, coronary history, and perception about the illness risk factors can be effective in referral to CR. In addition, the presence of CR centers in towns and facilitated achievement to these centers can play a significant role in patients' participation.

Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors.

Introduction: The causal attributions and perceived risk factors can affect patients' health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress. Methods: In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF's change scores on DASS-21 Stress scale scores using linear regression analysis. Results: Results showed that CR has a little impact in improving the patients' perception of heart risk factors, However, CR is significantly effective in reducing stress (P < 0.05). Regression analysis evidenced that improvements in patients' perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results. Conclusion: PHRFs appear to be significant predictive components of CR's stress reduction. Practitioners should focus on patients' perception of risk factors to facilitate stress management in CR program.

Efficacy of Alternative Cardiac Rehabilitation Delivery Formats in Improving Psychological Symptoms after Coronary Artery Bypass Grafting.

Background: Health-care systems always strive for alternative cardiac rehabilitation (CR) models to ensure that options available to patients better fit their needs, risk factor profiles, and preferences. We assessed the effects of hospital-based cardiac rehabilitation (HBCR) and hybrid cardiac rehabilitation (HCR) on psychological symptoms (i.e., anxiety, depression, and stress) among patients following coronary artery bypass graft surgery (CABG). Methods: This cross-sectional study recruited 115 CABG patients who were referred to the Department of Cardiac Rehabilitation at Imam Ali Hospital in the Iranian city of Kermanshah between January and May 2016. The patients were assigned to 1 of the 2 programs of HBCR (26 sessions) and HCR (10 sessions). The study population's psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS) before and after the intervention, and the data were analyzed using paired t-tests and ANCOVA. Results: A total of 105 (91%) patients concluded the CR program. Respectively, 50.8% and 26.2% of the participants in the HBCR and HCR programs were female. The mean age was 59.6±9.2 years in the HBCR group and 58.7±6.1 years in the HCR group. The ANCOVA results indicated that both HBCR and HCR programs were equally effective in reducing anxiety (P=0.001 vs. P=0.015) and stress (P=0.002 vs. P=0.003) among the CABG patients, while only HBCR was effective in alleviating depressive symptoms (P=0.001). Conclusion: Our results demonstrated the efficacy of HBCR and HCR in diminishing stress and anxiety levels among the CABG patients. However, depression was affected only by HBCR.

Design and standardization of tools for assessing the perceived heart risk and heart health literacy in Iran.

OBJECTIVES: The aim is to achieve the standard tools for heart health, the present study aimed to design, develop, and standardize the two questionnaires of perceived heart risk scale (PHRS) and heart health literacy scale (HHLS). METHODS: The present study was a methodological research conducted on the residents of Kermanshah Province, Iran, using the multi-stage cluster sampling. Further, considering the scientific methods in the psychometric field, the design of the research questionnaires was conducted. In addition, the viewpoints of experts in different domains were qualitatively and quantitatively included to assess the validity of the questionnaires. To assess the reliability of the questionnaires, a sample including 31 subjects was first selected and studied within a fortnight's interval. Then, the reliability and validity of the scales were assessed using factor analysis and Cronbach's alpha in a sample of 771 subjects. RESULTS: After reviewing the viewpoints of experts, the items were adjusted and implemented in the first sample at two stages. The results were indicative of the stability and acceptability of the Cronbach's alpha. In addition, the validity and reliability of the questionnaires were confirmed in the second sample too. CONCLUSION: According to the results of the present study, it can be concluded that the two questionnaires of PHRS and HHLS had acceptable reliability and validity.

A hybrid cardiac rehabilitation is as effective as a hospital-based program in reducing chest pain intensity and discomfort.

BACKGROUND: Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients. METHODS: In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA. RESULTS: The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P < 0.05). In addition, the comparison of scores before and after treatment using ANCOVA shows that no significant differences were observed between the two programs (P > 0.05). CONCLUSIONS: Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.

Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention.

BACKGROUND: Patients' beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor. MATERIALS AND METHODS: In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions. RESULTS: Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%). CONCLUSION: Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.

What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program?

BACKGROUND: To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR) program. METHODS: The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson's Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. RESULTS: About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 ± 2.52 vs. 49.30 ± 0.89; P = 0.042). Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P < 0.050); however, no significant difference was observed between different age groups in male patients (P > 0.050). CONCLUSION: Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs.

The relationship between brain behavioral systems and the characteristics of the five factor model of personality with aggression among Iranian students.

BACKGROUND: Aggression is one of the negative components of emotion and it is usually considered to be the outcome of the activity of the Behavioral Inhibition and the Behavioral Activation System (BIS/BAS): components which can be considered as predisposing factors for personality differences. Therefore, the purpose of this study was to investigate the relationship between brain behavioral systems and the characteristics of the five factor model of personality with aggression among students. METHODS: The present study has a correlation descriptive design. The research population included all of the Razi University students in the academic year of 2012-2013. The sampling was carried out with a random stratified method and 360 people (308 female and 52 male) were studied according to a table of Morgan. The study instruments were Buss and Perry Aggression Questionnaire, NEO Personality Inventory (Short Form), and Carver and White scale for BAS/BIS. Finally, SPSS20 was utilized to analyze the data using Pearson correlation, regression analysis, and canonical correlation. RESULTS: The data showed a significant positive relationship between the neurosis and agreeableness personality factors with aggression; but there is a significant negative relationship between the extroversion, openness, and conscientiousness personality factors with aggression. Furthermore, there is a significant positive relationship between all the components of brain behavioral systems (impulsivity, novelty seeking, sensitivity, tender) and aggression. The results of regression analysis indicated the personality characteristics and the brain behavioral systems which can predict 29 percent of the changes to aggression, simultaneously. CONCLUSIONS: According to a predictable level of aggressiveness by the personality characteristics and brain behavioral systems, it is possible to identify the personality characteristics and template patterns of brain behavioral systems for the students which be presented to them as a necessary training in order to control and manage of anger and aggression.