Abstract
Background:
Acute myocardial infarction (AMI) poses significant psychosocial challenges to patients during recovery, especially for young and middle-aged patients returning to work. This study examines the effects of music therapy combined with dyadic coping (DC) on the psychosocial adaptation and marital well-being of patients with AMI and their spouses.
Methods:
This retrospective cohort study included 60 couples of young and middle-aged patients with AMI admitted to Wuxi Second People’s Hospital from January 2024 to June 2024 and their spouses. The subjects were divided into the following two groups: 30 couples received DC care (DC group), and 30 couples received music therapy combined with DC care (DCMT group). The treatment course was 2 weeks. Outcomes were measured using the Multidimensional Infarction Assessment Scale (MIDAS), the Psychological Adjustment to Illness Scale Self-report (PAIS-SR), the Dyadic Coping Inventory (DCI), the Locke–Wallace Marital Adjustment Test (LWMAT) and the General Well-Being Schedule (GWBS).
Results:
Compared with the DC group, the DCMT group demonstrated significant improvements across all measured scales, including higher scores on the physical activity and emotional response dimensions of MIDAS, 10 dimensions of DCI and lower scores of all seven dimensions of PAIS-SR (P < 0.05). The total LWMAT and GWBS scores and the nursing satisfaction level in the DCMT group were higher than those in the DC group (P < 0.05).
Conclusion:
Music therapy combined with DC significantly enhances psychosocial adaptation and marital well-being in patients with AMI and their spouses.
Keywords: Acute myocardial infarction, dyadic coping, marital therapy, music therapy, psychosocial functioning
KEY MESSAGES
-
(1)
Integrating music therapy into dyadic coping significantly enhances psychosocial adaptation and spousal support in young and middle-aged patients with acute myocardial infarction (AMI).
-
(2)
Music therapy combined with dyadic coping can promote AMI patients’ recovery, allowing them to return to work more quickly.
-
(3)
The combined therapy not only improves the marital relationship of AMI patients, but also improves patients’ general well-being.
-
(4)
Music therapy combined with dyadic coping offers an effective approach for young and middle-aged patients to return to work after AMI.
INTRODUCTION
Acute myocardial infarction (AMI) represents a remarkable global health burden, characterised by high morbidity and mortality rates.[1] As medical advancements have improved the survival rates of patients with AMI, attention is increasingly shifting towards the psychosocial challenges that patients face during recovery, especially returning to work and reintegrating into daily life.[2] The psychosocial implications of AMI extend beyond the individual, affecting familial dynamics, particularly the well-being of spouses who often assume the role of primary caregivers.[3] The psychosocial implications of AMI underscores the need for comprehensive rehabilitation strategies that encompass the medical and psychosocial dimensions of patient care. Young and middle-aged patients with AMI present unique psychosocial adaptation challenges because they often bear important family roles and face occupational stress. Recent evidence suggested that addressing these psychosocial elements through supportive care strategies could significantly improve patients’ health outcomes, help them return to work and enhance their general well-being.[4]
The dyadic coping (DC) strategy, conceptualised within the broader framework of couple and family therapies, has been shown to improve emotional bonds of couples, enhance their marital satisfaction and promote resilience against external stressors.[5] By treating a couple as a singular interactive unit, DC nursing aims to harness the strengths and resources within the couple’s relationship to foster psychosocial adaptation.[6] In this context, spouses can offer consistent emotional support, assist with healthcare management and collaborate in making wise health-related decisions, which can be beneficial for the patient and the spouse’s familial well-being. Given the heavy burden that patients’ spouses often experience, enhancing their coping capacity is crucial for sustaining couples’ mental health and family relationship.[7]
Music therapy is a widely used and evidence-based psychotherapy that can improve patients’ physical, emotional and social functioning.[8] Research has shown that music can influence several physiological and psychological pathways, including blood pressure regulation, reduction in anxiety and depression and enhancement of mood.[9,10] Music therapy can help patients better cope with the emotional and psychological challenges associated with AMI by creating a supportive and therapeutic environment, ultimately improving psychosocial adaptation and quality of life.[11]
Integrating music therapy into DC nursing represents a novel approach to rehabilitation.[12,13] As a non-verbal and creative therapeutic outlet, music can act as an expressive medium for patients and their spouses to process emotions and manage stress collectively, further augmenting the benefits of DC strategies. Existing literature predominantly explores these nursing methods in isolation, without adequately considering their synergetic potential.[11] The unique benefits of these nursing methods for young and middle-aged adults who face distinct challenges in terms of work reintegration and familial responsibilities after AMI have not been extensively studied. This study seeks to investigate the synergistic effects of music therapy and DC nursing on improving the psychosocial adaptation and familial well-being of patients with AMI.
MATERIALS AND METHODS
Case selection
This retrospective cohort study included 60 couples of young and middle-aged patients with AMI and their spouses. The patients were admitted to the Department of Cardiology in Wuxi Second People’s Hospital from January 2024 to June 2024. Follow-up assessments were conducted 1 week after they returned to work.
G*Power software was used to estimate the sample size, and the following formula was applied: n = [(Zα/2 + Zβ)2 × 2 × σ2]/Δ2, with a significance level (α) of 0.05 and a power (1−β) of 0.8. The effect size (Δ/σ) was set to 0.8. According to these parameters, the minimum required sample size was 26 patients per group. The initial sample size was 70 couples, of which 64 couples met the inclusion criteria. After four couples were excluded, the final sample included in this study was 60 couples. The subjects were then divided into the following two groups: 30 couples received DC care (DC group), and 30 couples received music therapy combined with DC care (DCMT group).
This study received approval from Wuxi Second People’s Hospital’s Ethics Committee (No. 2024-Y-10), and informed consent was obtained from all patients.
Inclusion and exclusion criteria
Inclusion criteria for patients
Aged between 18 and 59 years, diagnosed as AMI in accordance with the European Society of Cardiology criteria,[14] single coronary artery affected, underwent percutaneous coronary intervention (PCI), married or cohabiting with a partner for more than 1 year, with normal hearing function, completed at least high school education and returned to work after recovery.
Exclusion criteria for patients
Cognitive impairments; severe psychiatric disorders or physical disease (malignant tumours, liver or kidney dysfunction, chronic obstructive pulmonary disease requiring long-term oxygen therapy and severe rheumatoid arthritis) and unable to contact the patient’s spouse.
Inclusion criteria for spouses
The primary caregiver of the patient, with normal hearing function, adequate comprehension and communication skills and possessing at least a high school diploma.
Exclusion criteria for spouses
Cognitive or communication impairments, history of psychiatric disorders and presence of severe physical diseases.
[Figure 1] shows a flowchart of patient screening and study design.
Figure 1.
Flowchart of patient screening and study design. Notes: AMI, acute myocardial infarction; DC, dyadic coping; DCMT: dyadic coping combined with music therapy.
Nursing method
group*DC
The DC group received DC care. Firstly, assess the patients’ physical needs, psychological needs, social needs, care preferences and issues related to communication and emotional expression between the patients and their spouses. Secondly, conduct activities focusing on DC and marital relationships. The specific methods are as follows: (1) starting from the second day of patients’ admission, their spouses received 45–60 minutes of instructions lasting for 1 week. They were encouraged to learn about AMI and how to recognise and manage adverse drug reactions. The spouses were asked to assist patients with rehabilitation and daily activities and offer patience and encouragement during patients’ emotional difficulties. They were also advised to provide comfort to other family members and manage social responsibilities. The couples were encouraged to give small gifts to each other, such as handmade items or jewellery. (2) Self-disclosure sessions were conducted weekly for 40–60 minutes through verbal or written communication in a quiet instructional room. When one partner was disclosing, the other was asked to listen attentively and appropriately respond. The couples needed to work together to resolve issues raised during the disclosure process.
DCMT group
The DCMT group received music therapy combined with DC care. The music therapy was facilitated by professional music therapists. The therapists selected songs on the basis of detailed instructions from the medical staff and each patient’s musical tastes and preferences. Patients were provided with high-quality headphones and portable music players preloaded with their selected playlists. Music sessions were conducted once daily for 30–40 minutes in a supportive environment. The participants spent 20–25 minutes listening to their selected songs and then shared their thoughts and emotional responses with their spouses for 10–15 minutes. Music therapists regularly visited each ward to check on the progress of music therapy sessions. They also facilitated brief follow-up discussions to ensure that patients felt supported and understood throughout the process.
Outcome measures
Baseline data
Clinical information of the patients was collected through the hospital medical records. The demographic characteristics included the following: gender; age; educational level; occupational categories; monthly income; smoking and drinking history; body mass index (BMI); comorbidities (diabetes, hypertension, hyperlipidaemia and anaemia) and number of children. The baseline disease features included infarct-related artery, Killip Classification, left ventricular ejection fraction (LVEF) and hospital stay. LVEF was measured using a GE Vivid E95 echocardiography (GE HealthCare, USA).
Quality of life
The Myocardial Infarction Dimensional Assessment Scale (MIDAS) was employed to evaluate AMI patients’ quality of life 1 week after returning to work. MIDAS consists of seven subscales: physical activity (one item), emotional response (four items), dependency (three items), diet management (three items), safety (nine items), medication concerns (two items) and side effects (two items). Each item was rated using a 5-point Likert scale, where 0 indicates ‘never’, 1 indicates ‘rarely’, 2 indicates ‘sometimes’, 3 indicates ‘often’ and 4 indicates ‘always’. The total possible score is 140, with higher scores indicating lower quality of life. The Cronbach’s α for this scale was 0.93, demonstrating high internal consistency.[15]
Psychosocial adaptation
Psychosocial adaptation function was assessed using the Psychosocial Adjustment to Illness Scale Self-report (PAIS-SR) 1 week after patients returned to work. The scale encompasses seven dimensions: healthcare orientation, vocational environment, domestic environment, sexual relationships, extended family relationships, social environment and psychological distress. The Chinese version of the PAIS-SR scale contains 44 items, with each item ranging from 0 point to 3 points and a total score of 132 points. Higher scores indicated poorer psychosocial adaptation function. The Cronbach’s α for the scale was 0.939, indicating good internal consistency.[16]
DC capacity
The Dyadic Coping Inventory (DCI) was used to evaluate the mutual support between couples when facing stressful events 1 week after the patients with AMI returned to work. DCI includes 10 dimensions: stress communicated by oneself, stress communication of the partner, supportive DC by oneself, supportive DC of the partner, delegated DC by oneself, delegated DC of the partner, negative DC by oneself, negative DC of the partner, common DC and evaluation of DC (EDC). It consists of 35 items rated on a 5-point Likert scale, ranging from ‘very rarely’ (1) to ‘very frequently’ (5). The total score was the sum of items 1–35, with items 7, 10, 11, 15, 22, 25, 26 and 27 reversely scored. Items 36 and 37 in EDC were not included in the total score. Higher scores indicated greater mutual support between the couple. The Cronbach’s α ranged from 0.74 to 0.93,[17] indicating good to excellent internal consistency.
Marital adjustment
The Locke–Wallace Marital Adjustment Test (LWMAT) was used assess the adaptation and satisfaction of patients with AMI with their marital relationship pre-nursing (first day after PCI) and post-nursing (1 week after they returned to work). The first item of LWMAT evaluates global happiness; the subsequent eight items examine the level of agreement on particular topics, including finances, recreation, affection, friends and philosophy of life. The remaining six items focus explicitly on specific decisions and emotional responses concerning the marriage and the patient’s spouse. The total score was the sum of all item scores, ranging from 2 to 158. Higher scores indicated greater marital intimacy and higher marital quality. A score below 100 indicated marital discord, whereas a score of 100 or above suggested good marital adjustment. The Cronbach’s α for the scale was 0.78,[18] indicating respectable internal consistency.
General well-being
The General Well-Being Schedule (GWBS) was used to evaluate an individual’s general well-being pre-nursing and post-nursing. It consists of six dimensions: positive well-being, self-control, vitality, depression, anxiety and general health. Scores below 48 indicated low well-being, scores between 49 and 72 indicated moderate well-being and scores between 73 and 110 indicated high well-being. GWBS showed reliable internal consistency (Cronbach’s α: 0.91 for males and 0.95 for females) and construct validity (Pearson’s correlations: 0.65–0.88) in a Chinese population.[19]
Nursing satisfaction
The nursing satisfaction of the two groups was evaluated using a hospital-designed questionnaire 1 week after patients returned to work. The questionnaire encompassed the following six dimensions: nursing professionalism, communication and attitude, comfort during care, response speed, psychological support and education and information provision. The questionnaire consisted of 20 items, with a maximum possible score of 100 points. Satisfaction levels were categorised as follows: very satisfied (90–100), fairly satisfied (60–89) and dissatisfied (below 60). The nursing satisfaction increases with higher scores. The reliability of the questionnaire was assessed through a pilot study involving 50 participants who had similar characteristics to the current study population. The Cronbach’s α of the self-developed scale was 0.71 based on the pilot study, indicating acceptable internal consistency.
Statistical analysis
Data analysis was performed using SPSS statistical software (version 29.0, SPSS Inc., Chicago, IL, USA). Categorical data were represented by frequencies and percentages [n (%)] and analysed using chi-square test. Continuous variables were assessed for normality using Shapiro-Wilk test. If normally distributed, data were presented as mean ± standard deviation (x± s) and compared using t-tests. P < 0.05 was considered statistically significant.
Tables were created using Microsoft Word LTSC MSO (version 2312, Build 16.0.17126.20132, Microsoft Corporation, USA). Figures were generated using R programming language (version 4.1.2, R Foundation for Statistical Computing, Vienna, Austria).
RESULTS
Demographics characteristics
The demographics characteristics of the patients are shown in Table 1. Gender; age; educational level; occupational categories; monthly income; comorbidities (diabetes, hypertension, hyperlipidaemia and anaemia); smoking and drinking history and BMI showed no significant differences between the two groups (P > 0.05). This finding suggests that the DC and DCMT groups were well matched at baseline, allowing for unbiased comparison of the outcome measures.
Table 1.
Demographics characteristics of DC and DCMT groups
| Parameter | DC group (n = 30) | DCMT group (n = 30) | t/χ2 | P |
|---|---|---|---|---|
| Gender | 0.271 | 0.602 | ||
| Female | 18 (60.00%) | 16 (53.33%) | ||
| Male | 12 (40.00%) | 14 (46.67%) | ||
| Age (year) | 37.52 ± 3.51 | 37.19 ± 3.63 | 0.364 | 0.717 |
| Educational level | 0.268 | 0.605 | ||
| High school or below | 15 (50.00%) | 13 (43.33%) | ||
| College or above | 15 (50.00%) | 17 (56.67%) | ||
| Occupation | 0.855 | 0.836 | ||
| Worker | 11 (36.67%) | 9 (30.00%) | ||
| Government agencies | 3 (10.00%) | 5 (16.67%) | ||
| Enterprise employee | 12 (40.00%) | 11 (36.67%) | ||
| Others | 4 (13.33%) | 5 (16.67%) | ||
| Monthly income (CNY) | 0.134 | 0.935 | ||
| <3000 | 5 (16.67%) | 6 (20.00%) | ||
| 3000–6000 | 13 (43.33%) | 13 (43.33%) | ||
| >6000 | 12 (40.00%) | 11 (36.67%) | ||
| Number of children | 0.098 | 0.754 | ||
| 0 | 7 (23.33%) | 6 (20%) | ||
| ≥1 | 23 (76.67%) | 24 (80%) | ||
| Diabetes | 8 (26.67%) | 7 (23.33%) | 0.089 | 0.766 |
| Hypertension | 11 (36.67%) | 12 (40.00%) | 0.071 | 0.791 |
| Hyperlipidaemia | 9 (30.00%) | 11 (36.67%) | 0.300 | 0.584 |
| Anaemia | 4 (13.33%) | 8 (26.67%) | 1.667 | 0.197 |
| Smoking history | 12 (40.00%) | 14 (46.67%) | 0.271 | 0.602 |
| Drinking history | 14 (46.67%) | 15 (50.00%) | 0.067 | 0.796 |
| BMI (kg/m2) | 24.32 ± 2.43 | 24.74 ± 2.44 | 0.672 | 0.505 |
Notes: BMI, body mass index; CNY, Chinese yuan; DC, dyadic coping; DCMT, dyadic coping combined with music therapy.
Baseline disease features
The baseline disease features of patients are shown in Table 2. No significant differences existed in the infarct-related arteries, Killip Classification, LVEF and hospital stay between the two groups (P > 0.05). This result confirmed the homogeneity of disease-related characteristics between the DC and DCMT groups at baseline.
Table 2.
Baseline disease features of DC and DCMT groups
| Parameters | DC group(n = 30) | DCMT group(n = 30) | t/χ2 | P |
|---|---|---|---|---|
| Infarct-related artery | 0.740 | 0.691 | ||
| Left circumflex | 6 (20.00%) | 7 (23.33%) | ||
| Left anterior descending | 14 (46.67%) | 16 (53.33%) | ||
| Right coronary | 10 (33.33%) | 7 (23.33%) | ||
| Killip classification | 0.313 | 0.855 | ||
| Class II | 16 (53.33%) | 18 (60.00%) | ||
| Class III | 10 (33.33%) | 9 (30.00%) | ||
| Class IV | 4 (13.33%) | 3 (10.00%) | ||
| Left ventricular ejection fraction (%) | 46.24 ± 4.74 | 46.95 ± 4.53 | 0.591 | 0.557 |
| Hospital stay (day) | 18.69 ± 1.87 | 19.35 ± 1.73 | 1.419 | 0.161 |
Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy.
MIDAS
The MIDAS scores of the patients are shown in Table 3. The DCMT group demonstrated higher scores in all seven subscales, including physical activity (P = 0.006), emotional response (P = 0.011), dependency (P = 0.006), diet management (P = 0.015), safety (P = 0.002), medication concerns (P = 0.036) and side effects (P = 0.028), than the DC group. Overall, the total MIDAS score was significantly higher in the DCMT group than in the DC group (P = 0.001), indicating an enhanced psychosocial adaptation for patients with AMI receiving music therapy combined with DC care.
Table 3.
MIDAS scores of the two groups 1 week after returning to work
| MIDAS | DC group (n = 30) | DCMT group (n = 30) | t | P |
|---|---|---|---|---|
| Physical activity | 38.63 ± 4.74 | 42.36 ± 5.39 | 2.846 | 0.006 |
| Emotional response | 11.57 ± 3.46 | 14.33 ± 4.62 | 2.614 | 0.011 |
| Dependency | 8.45 ± 2.78 | 10.67 ± 3.18 | 2.871 | 0.006 |
| Diet management | 7.93 ± 2.74 | 10.42 ± 4.66 | 2.524 | 0.015 |
| Safety | 29.53 ± 4.82 | 33.67 ± 5.15 | 3.209 | 0.002 |
| Medication concerns | 6.74 ± 2.64 | 8.13 ± 2.36 | 2.146 | 0.036 |
| Side effects | 5.24 ± 2.78 | 6.91 ± 2.96 | 2.250 | 0.028 |
| Total MIDAS score | 109.57 ± 14.67 | 122.61 ± 15.34 | 3.366 | 0.001 |
Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy; MIDAS, Myocardial Infarction Dimensional Assessment Scale.
Psychological adaptation
The DCMT group scored lower in healthcare orientation (P = 0.021), vocational environment (P = 0.006), domestic environment (P = 0.022), sexual relationships (P = 0.004), extended family relationships (P = 0.003), social environment (P = 0.001), psychological distress (P = 0.009) and total PAIS-SR score (P = 0.008). This result indicated that music therapy combined with DC enhances the psychosocial adaptation of young and middle-aged patients with AMI [Table 4].
Table 4.
PAIS-SR scores of the two groups 1 week after returning to work
| PAIS-SR dimension | DC group (n = 30) | DCMT group (n = 30) | t | P |
|---|---|---|---|---|
| Healthcare orientation | 9.74 ± 5.86 | 6.46 ± 4.74 | 2.381 | 0.021 |
| Vocational environment | 13.39 ± 4.79 | 10.23 ± 3.74 | 2.849 | 0.006 |
| Domestic environment | 5.86 ± 3.56 | 3.97 ± 2.54 | 2.357 | 0.022 |
| Sexual relationships | 7.45 ± 4.28 | 4.62 ± 2.81 | 3.020 | 0.004 |
| Extended family relationships | 4.76 ± 2.71 | 3.01 ± 1.28 | 3.196 | 0.003 |
| Social environment | 5.56 ± 2.76 | 3.63 ± 1.34 | 3.450 | 0.001 |
| Psychological distress | 6.43 ± 2.81 | 4.76 ± 1.86 | 2.714 | 0.009 |
| Total PAIS-SR score | 59.98 ± 16.51 | 48.76 ± 15.36 | 2.726 | 0.008 |
Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy; PAIS-SR, Psychosocial Adjustment to Illness Scale Self-report.
DC capacity
The scores of all dimensions of DCI in the DCMT group were higher than those in the DC group (P < 0.05), suggesting that music therapy combined with DC care significantly enhances the coping strategies of young and middle-aged patients with AMI [Table 5].
Table 5.
DCI scores of DC and DCMT groups 1 week after returning to work
| DCI dimension | DC group (n = 30) | DCMT group (n = 30) | t | P |
|---|---|---|---|---|
| SCO | 5.85 ± 1.77 | 7.68 ± 2.46 | 3.324 | 0.002 |
| SCP | 6.36 ± 1.57 | 8.12 ± 2.32 | 3.447 | 0.001 |
| SDC | 13.87 ± 2.37 | 15.86 ± 3.56 | 2.547 | 0.014 |
| SDCP | 15.23 ± 2.18 | 17.38 ± 3.74 | 2.710 | 0.009 |
| DDCO | 5.38 ± 2.67 | 7.37 ± 3.17 | 2.632 | 0.011 |
| DDCP | 6.22 ± 2.36 | 8.13 ± 3.45 | 2.505 | 0.015 |
| NDCO | 11.47 ± 2.86 | 13.90 ± 3.86 | 2.768 | 0.008 |
| NDCP | 11.41 ± 2.97 | 13.25 ± 2.46 | 2.604 | 0.012 |
| CDC | 14.49 ± 4.26 | 17.36 ± 3.39 | 2.886 | 0.005 |
Notes: CDC, common dyadic coping; DC, dyadic coping; DCI, the Dyadic Coping Inventory; DCMT, dyadic coping combined with music therapy; DDCO, delegated dyadic coping by oneself; DDCP, delegated dyadic coping of the partner; SCO, stress communicated by oneself; SCP, stress communication of the partner; SDC, supportive dyadic coping by oneself; SDCP, supportive dyadic coping of the partner; NDCO, negative dyadic coping by oneself; NDCP, negative dyadic coping of the partner.
Marital adjustment
The pre-nursing scores of the total LWMAT score were statistically comparable between the groups (P > 0.05). The post-nursing LWMAT score was significantly higher in the DCMT group (P < 0.001) than in the DC group (P = 0.003), indicating that music therapy combined with DC care significantly enhances marital adjustment in young and middle-aged patients with AMI [Table 6].
Table 6.
LWMAT score of DC and DCMT groups
| Total LWMAT score | DC group (n = 30) | DCMT group (n = 30) | t | P |
|---|---|---|---|---|
| Pre-nursing | 92.67 ± 4.87 | 93.52 ± 3.38 | 0.784 | 0.436 |
| Post-nursing | 93.45 ± 12.45 | 103.28 ± 12.39 | 3.066 | 0.003 |
| t | 0.284 | 4.210 | ||
| P | 0.778 | < 0.001 |
Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy; LWMAT, Locke–Wallace Marital Adjustment Test.
General well-being
The pre-nursing scores of both groups showed no significant difference (P > 0.05) [[Figure 2]. The post-nursing GWBS score was significantly higher in the DCMT group than in the DC group (91.55 ± 6.71 vs. 86.34 ± 7.45; t = 2.850, P = 0.006), indicating that music therapy combined with DC care enhances the general well-being of young and middle-aged patients with AMI, thereby benefitting their familial environments.
Figure 2.
GWBS scores of DC and DCMT groups. Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy; GWBS, General Well-Being Schedule; ns, no statistically significant difference; **, P < 0.01.
Nursing satisfaction
Nursing satisfaction was significantly higher in the DCMT group than in the DC group (χ2 = 9.700, P = 0.008), indicating that music therapy combined with DC significantly enhances the nursing satisfaction amongst young and middle-aged patients with AMI [Table 7].
Table 7.
Comparison of nursing satisfaction between two groups
| Satisfaction level | DC group (n = 30) | DCMT group (n = 30) | χ 2 | P |
|---|---|---|---|---|
| Very satisfied | 10 (33.33%) | 22 (73.33%) | 9.700 | 0.008 |
| Fairly satisfied | 14 (46.67%) | 6 (20.00%) | ||
| Dissatisfied | 6 (20.00%) | 2 (6.67%) |
Notes: DC, dyadic coping; DCMT, dyadic coping combined with music therapy.
DISCUSSION
Returning to work is a critical milestone for patients recovering from AMI because it signifies a return to normalcy and improved functional capacity.[20] However, this transition can be fraught with stress and anxiety, particularly if the patient experiences residual symptoms or fears about recurrent events.[21] For young and middle-aged patients, couple therapy can improve their familial well-being and psychosocial adaptability, help promote disease recovery and help them return to work as soon as possible.
Quality of life
In this study, the DCMT group showed significantly higher scores in emotional response, dependency management, dietary management and safety of MIDAS score than the DC group.
Studies on neurological diseases have shown that music directly affects the brain’s limbic system, thereby regulating emotions and physiological responses.[22,23] A meta-analysis reported that music therapy could influence several physiological and psychological pathways; it not only helps reduce anxiety and depression but also positively affects blood pressure regulation and overall mood enhancement.[24] The combination of music therapy with DC care may thus create a reinforcing loop where stress is managed through joint efforts and emotional expression is facilitated through music, ultimately leading to a holistic improvement in health outcomes and quality of life.[25]
Psychological adaptation
The DCMT group had significant lower PAIS-SR scores than the DC group, suggesting that music therapy combined with DC effectively addresses multiple aspects of psychosocial adaptation, leading to reduced psychological distress and enhanced overall functioning.
Music serves as a medium for emotional expression, helping patients and their spouses better understand and empathise with each other’s feelings, thereby strengthening their communication and support. By engaging in shared musical activities, couples can explore and articulate complex emotions, which is particularly beneficial for those recovering from AMI. This process not only alleviates stress but also fosters a supportive environment that promotes mutual understanding and resilience, which are key components of effective psychosocial adaptation.[26,27]
DC capacity and marital adjustment
The DC strategy views the couple as a singular dyadic unit. It underscores the importance of addressing health challenges as a shared experience between patients and their spouses and foster mutual empathy, improved communication and shared resilience.[28,29] DC encourages mutual support, shared understanding and collaborative management of stress.[30]
The DCI scores revealed significant enhancements in various coping strategies amongst participants in the DCMT group. For patients and their spouses, openly sharing feelings and concerns can validate each partner’s experiences, enhance empathy and reduce feelings of isolation, which are common after a major health event. Music therapy further complements DC by offering a non-verbal, expressive outlet for patients and their spouses to process emotions, reduce stress and improve overall well-being.[8] DCMT enhances not only emotional connection but also coping mechanisms, as evidenced by the higher DCI scores in the DCMT group.
The LWMAT results indicated that the DCMT group had significantly higher scores in emotional expression, marital cohesion, marital consensus and marital satisfaction than the DC group. This finding further supports the role of music therapy in enhancing emotional connections and marital quality. Music, as a shared experience, can strengthen interactions and emotional bonds between couples, thereby increasing their marital satisfaction.[31,32] Music can also foster an environment where partners feel safe to communicate and express emotions, which can considerably improve the quality of their relationship, as reflected in the higher LWMAT scores observed in the DCMT group.
General well-being and satisfaction
The GWBS results showed significant improvement in overall well-being for the DCMT group. DCMT positively affects familial environments, fostering a supportive atmosphere conducive to recovery and long-term health. Music therapy contributes to a more supportive family environment, thus enhancing the overall well-being of family members.
Nursing satisfaction was significantly higher in the DCMT group than in the DC group. The structured and empathetic approach of music therapy may provide nurses with additional tools to engage effectively with patients and their families, leading to increased levels of perceived support and satisfaction amongst caregivers and recipients.[33]
Limitations
One of the primary limitations of this study is the relatively small sample size, which may have reduced the statistical power of the study. The study participants were predominantly from a single cultural background, which may have introduced cultural biases into the results. Additionally, the study design was limited in its duration, focusing primarily on short-term outcomes. Therefore, the long-term effects of DC care remain uncertain.
There is a notable detail that the baseline data for MIDAS, PAIS-SR and DCI were not collected prior to DC care. This study primarily aimed to investigate the psychosocial adaptation and marital well-being of patients with AMI after returning to work. Therefore, post-discharge assessments were prioritised to capture the long-term benefits of DC care on the patients’ ability to reintegrate into work and the society.
Another potential limitation is the relatively young average age of the participants. Myocardial infarction is more commonly observed in individuals over 40 years of age. This study focused on patients who have experienced AMI but are still in the working age range and have a stable partner. Whilst the younger age of the participants may have limited the generalisability of the findings to older populations, it provides valuable insights into the effectiveness of these nursing methods in younger adults.
The analysis of demographic characteristics showed that the participants in this study had a higher history of smoking and drinking, may be because smoking and excessive drinking are known risk factors for cardiovascular diseases, including AMI.
Future studies should adopt a prospective design with larger and more diverse samples. Assessing the long-term sustainability of music therapy is crucial. Longitudinal studies can track changes over time, providing valuable insights into the temporal dynamics of therapeutic effects. How different genres and styles of music influence therapeutic outcomes must be investigated. Comparative studies could identify which types of music are most effective for specific conditions or patient groups. Finally, future studies should explicitly account for cultural factors by including culturally diverse populations and incorporating culturally sensitive measures.
CONCLUSION
The combination of DC with music therapy represents a promising nursing strategy for improving psychosocial adaptation among patients with AMI and enhancing familial well-being among spouses. This approach recognises the interconnected nature of patient and spouse experiences; harnessing the power of joint resources and support to foster resilience, communication and mutual care. The findings have important implications for developing comprehensive, integrative rehabilitation programs that cater to patients and their support networks, ultimately leading to more sustainable health outcomes and improved quality of life.
Future research could expand on these findings by exploring additional therapeutic modalities that complement music therapy strategies and examining the long-term effects of such nursing methods on health and relationship dynamics.
Availability of data and materials
The datasets used during the present study are available from the corresponding author upon reasonable request.
Author contributions
CXW, FL and XL designed the study. XQ, MS and YZ provided help and advice on the experiments. CXW, FL, XL and YZ analysed the data. RRW provided administrative support for this research. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.
Ethics approval and consent to participate
This study was reviewed and approved by the ethics committee of Wuxi Second People’s Hospital (No.2024-Y-10), and informed consent has been obtained from all patients.
Conflicts of Interest
The authors have no conflicts of interest to declare.
Acknowledgement
Not applicable.
Funding Statement
This study was supported by the Wuxi Nursing Society Research Project (No. M202302).
REFERENCES
- 1.Frampton J, Ortengren AR, Zeitler EP. Arrhythmias after acute myocardial infarction. Yale J Biol Med. 2023;96:83–94. doi: 10.59249/LSWK8578. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Femia G, French JK, Juergens C, Leung D, Lo S. Right ventricular myocardial infarction: pathophysiology, clinical implications and management. Rev Cardiovasc Med. 2021;22:1229–40. doi: 10.31083/j.rcm2204131. [DOI] [PubMed] [Google Scholar]
- 3.Kapur NK, Thayer KL, Zweck E. Cardiogenic shock in the setting of acute myocardial infarction. Methodist Debakey Cardiovasc J. 2020;16:16–21. doi: 10.14797/mdcj-16-1-16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Zeymer U, Bueno H, Granger CB, et al. Acute cardiovascular care association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: a document of the Acute Cardiovascular Care Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care. 2020;9:183–97. doi: 10.1177/2048872619894254. [DOI] [PubMed] [Google Scholar]
- 5.Wendołowska AM, Czyżowska D, Siwek M. The dyadic coping model of bipolar disorder patients. Psychiatr Pol. 2021;55:1009–24. doi: 10.12740/PP/OnlineFirst/118840. [DOI] [PubMed] [Google Scholar]
- 6.Tang N, Jia Y, Zhao QH, et al. Influencing factors of dyadic coping among infertile women: a path analysis. Front Psychiatry. 2022;13:830039. doi: 10.3389/fpsyt.2022.830039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Zhang L, Gu W, Jing X, et al. Predicting the dyadic coping through self-esteem among infertile couples undergoing in vitro fertilization and embryo transfer: an actor-partner interdependence model. Front Psychol. 2023;14:1127464. doi: 10.3389/fpsyg.2023.1127464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.de Witte M, Pinho ADS, Stams GJ, Moonen X, Bos AER, van Hooren S. Music therapy for stress reduction: a systematic review and meta-analysis. Health Psychol Rev. 2022;16:134–59. doi: 10.1080/17437199.2020.1846580. [DOI] [PubMed] [Google Scholar]
- 9.Lorber M, Divjak S. Music therapy as an intervention to reduce blood pressure and anxiety levels in older adults with hypertension: a randomized controlled trial. Res Gerontol Nurs. 2022;15:85–92. doi: 10.3928/19404921-20220218-03. [DOI] [PubMed] [Google Scholar]
- 10.Ran R, Ying Y, Zhang W. Effects of music intervention on anxiety, depression symptoms and quality of life in breast cancer patients: a meta-analysis. Actas Esp Psiquiatr. 2023;51:250–61. [PMC free article] [PubMed] [Google Scholar]
- 11.Yao X, Jin Y, Gao C, et al. Phase I cardiac rehabilitation with 5-phase music after emergency percutaneous coronary intervention for acute myocardial infarction: a prospective randomized study. Medicine (Baltimore) 2023;102:e33183. doi: 10.1097/MD.0000000000033183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Saita E, Ferraris G, Acquati C, et al. Dyadic profiles of couples coping with body image concerns after breast cancer: preliminary results of a cluster analysis. Front Psychol. 2022;13:869905. doi: 10.3389/fpsyg.2022.869905. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Tang Q, Huang Z, Zhou H, Ye P. Effects of music therapy on depression: a meta-analysis of randomized controlled trials. PLoS One. 2020;15:e0240862. doi: 10.1371/journal.pone.0240862. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018;39:119–77. doi: 10.1093/eurheartj/ehx393. [DOI] [PubMed] [Google Scholar]
- 15.Wang W, Lopez V, Thompson DR. A Chinese mandarin translation and validation of the myocardial infarction dimensional assessment scale (MIDAS) Qual Life Res. 2006;15:1243–9. doi: 10.1007/s11136-006-0065-1. [DOI] [PubMed] [Google Scholar]
- 16.Li M, Yu B, He H, Li N, Gao R. Impact of psychological resilience and social support on psycho-social adjustment in postoperative patients with primary hepatocellular carcinoma: mediating effects of fear of progression. Front Psychol. 2024;15:1461199. doi: 10.3389/fpsyg.2024.1461199. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Xu F, Hilpert P, Randall AK, Li Q, Bodenmann G. Validation of the dyadic coping inventory with Chinese couples: factorial structure, measurement invariance, and construct validity. Psychol Assess. 2016;28:e127–40. doi: 10.1037/pas0000329. [DOI] [PubMed] [Google Scholar]
- 18.Cai T, Qian J, Huang Q, Yuan C. Distinct dyadic coping profiles in Chinese couples with breast cancer. Support Care Cancer. 2021;29:6459–68. doi: 10.1007/s00520-021-06237-2. [DOI] [PubMed] [Google Scholar]
- 19.Hua J, Zhu L, Du W, Du L, Luo T, Wu Z. Infant’s sex, birth control policy and postpartum well-being: a prospective cohort study in Shanghai, China. BMJ Open. 2016;6:e012207. doi: 10.1136/bmjopen-2016-012207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Wu X, Wang S, Cui H, et al. Machine learning-based return-to-work assessment system for acute myocardial infarction patients within 12 months. Heart Lung. 2025;73:19–25. doi: 10.1016/j.hrtlng.2025.04.020. [DOI] [PubMed] [Google Scholar]
- 21.Zhang Q, Ning L, Yang X, et al. Return to work experience of young and middle-aged patients with acute myocardial infarction: a longitudinal qualitative study. J Cardiovasc Nurs. 2024;39:465–76. doi: 10.1097/JCN.0000000000001019. [DOI] [PubMed] [Google Scholar]
- 22.Peck KJ, Girard TA, Russo FA, Fiocco AJ. Music and memory in Alzheimer’s disease and the potential underlying mechanisms. J Alzheimers Dis. 2016;51:949–59. doi: 10.3233/JAD-150998. [DOI] [PubMed] [Google Scholar]
- 23.Speranza L, Pulcrano S, Perrone-Capano C, di Porzio U, Volpicelli F. Music affects functional brain connectivity and is effective in the treatment of neurological disorders. Rev Neurosci. 2022;33:789–801. doi: 10.1515/revneuro-2021-0135. [DOI] [PubMed] [Google Scholar]
- 24.Lu G, Jia R, Liang D, Yu J, Wu Z, Chen C. Effects of music therapy on anxiety: a meta-analysis of randomized controlled trials. Psychiatry Res. 2021;304:114137. doi: 10.1016/j.psychres.2021.114137. [DOI] [PubMed] [Google Scholar]
- 25.Jia R, Liang D, Yu J, et al. The effectiveness of adjunct music therapy for patients with schizophrenia: a meta-analysis. Psychiatry Res. 2020;293:113464. doi: 10.1016/j.psychres.2020.113464. [DOI] [PubMed] [Google Scholar]
- 26.Kim AJ. Differential effects of musical expression of emotions and psychological distress on subjective appraisals and emotional responses to music. Behav Sci (Basel) 2023;13:491. doi: 10.3390/bs13060491. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Witusik A, Mosiołek A, Pietras T. Music therapy and psychotherapy − complementarity or antagonism in the treatment of patients with mental disorders. Pol Merkur Lekarski. 2024;52:453–6. doi: 10.36740/Merkur202404111. [DOI] [PubMed] [Google Scholar]
- 28.Cai T, Qian J, Yuan C. Dyadic coping in couples with breast cancer in China. Cancer Nurs. 2021;44:e458–66. doi: 10.1097/NCC.0000000000000884. [DOI] [PubMed] [Google Scholar]
- 29.Zhang L, Zhang Z, Mei Y, Liu Q. Dyadic appraisals, dyadic coping, and mental health among couples coping with stroke: a longitudinal study protocol. J Adv Nurs. 2020;76:3164–70. doi: 10.1111/jan.14495. [DOI] [PubMed] [Google Scholar]
- 30.Werner S, Hochman Y, Rosenne H, Kurtz S. Cooperation or tension? Dyadic coping in cystic fibrosis. Fam Process. 2021;60:285–98. doi: 10.1111/famp.12538. [DOI] [PubMed] [Google Scholar]
- 31.Kehl SM, La Marca-Ghaemmaghami P, Haller M, et al. Creative music therapy with premature infants and their parents: a mixed-method pilot study on parents’ anxiety, stress and depressive symptoms and parent-infant attachment. Int J Environ Res Public Health. 2020;18:265. doi: 10.3390/ijerph18010265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Stedje K, Kvamme TS, Johansson K, et al. The influence of home-based music therapy interventions on relationship quality in couples living with dementia-an adapted convergent mixed methods study. Int J Environ Res Public Health. 2023;20((4)):2863. doi: 10.3390/ijerph20042863. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Li C, Li P. Analysis of effect of music and art combined with kinect game therapy in improving the cognitive function and alleviating negative emotions of Alzheimer’s disease patients in a residential aged care facilities. Altern Ther Health Med. 2024;30:415–9. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used during the present study are available from the corresponding author upon reasonable request.
