Contrary to previous studies, which have looked at in-hospital recovery as a global experience, this study carves up the in-hospital recovery period into a series of specific challenges that patients face, and identifies the most effective and problematic coping skills for each challenge. In-hospital challenge outcomes are then related to post-discharge adjustment.

A patient-driven methodology was developed and employed throughout. Empirical data on hospital recovery "from a patient's point of view" was obtained, via private bedside interviews, 4 to 10 days after surgery. The data were then used to generate an original stress and coping questionnaire. 113 post-discharged CABG patients participated in a self-report mailout survey, based on the preliminary data and using the new instrument.

Hierarchical regression analysis, with control variables, showed that the specific coping strategies patients use are the paramount predictors of in-hospital emotional outcome. Across challenges, cognitive modes of coping were found to be more effective than instrumental modes.

Psychological Hardiness, perceived in-hospital social support, and demographics also contributed to the prediction of in-hospital affective states. Hardiness was an effective buffer of stress for some concrete challenges, but was actually found problematic for coping with some psycho-social challenges.

Post-discharge state anxiety, depressive affect, and PTSD symptomatology were predictable from in-hospital outcomes. Only negative in-hospital outcomes were predictive of later adjustment; positive in-hospital outcomes did not predict later affective states.

The results of this study suggest specific psychological and behavioral prescriptions for helping patients move emotionally through the major steps of in-hospital recovery. The results also identify particular behavioral "signs" that nursing and medical care staff can look out for, to recognize patients who may be in "silent" emotional difficulty. A means of identifying patients, prior to hospital discharge, who are most likely to experience particular post-discharge adjustment problems, is also suggested.