Heart-Focused Anxiety as a Mediator Between Illness Perception and Negative Affect in Cardiac Patients
Abstract
Backgrounds: Psychosocial risk factors related to cardiovascular diseases (CVDs) are associated with disease outcomes, quality of life, and higher mortality and morbidity. Common-Sense Model of Illness suggests that when people are confronted with an illness, they interpret their somatic sensations and develop their own perceptions of that illness in order to make sense of their condition. The way patients interpret their illness may lead to the occurrence of depression and anxiety. The aim of this research was to examine a possible mediating role of heart-focused anxiety (HFA) in the relationship between illness perception and depression and general anxiety. It was hypothesized that HFA would mediate the relationship between illness perceptions and depression/anxiety. Patients with more positive beliefs about the controllability of their illness would experience lower HFA and, as a result, lower levels of depression and general anxiety.
Methods: A total of 177 patients (70.6% male; mean age 63.4 years) hospitalized for major cardiac events participated in the study. They completed the Revised Illness Perception Questionnaire, the Cardiac Anxiety Questionnaire, and the Hospital Anxiety and Depression Scale.
Results: The results of the study clearly show that patients with CVD who express more positive beliefs about the disease, in terms of controllability, show fewer symptoms of anxiety and depression. Focusing on heart symptoms mediates the development of anxiety and depression, but only in CVD patients who believe that they cannot control their disease by treatment. Avoidance of certain activities is not significantly related to a person's perception of how well they can control the illness by themselves, but shows significant, although low, negative correlations with treatment control.
Conclusions: Psychological intervention for CVD patients designed to improve the understanding of cardiac disease and its symptoms and to modify maladaptive beliefs about the controllability of the illness may reduce HFA, as well as the negative affect in cardiac patients. The limitations of this study include the lack of patient follow-up after discharge from the hospital and a relatively small sample size. A significant contribution of this research is the better understanding of the beliefs about the disease in the recovery process and coping with CVD symptoms.
Keywords
Full Text:
PDFReferences
Al-Qezweny, M. N., Utens, E. M. W. J., Dulfer, K., Hazemeijer, B. A. F., van Geuns, R. J., Daemen, J., & van Domburg, R. (2016). The association between type D personality, and depression and anxiety ten years after PCI. Netherlands Heart Journal, 24(9), 538–543. https://doi.org/10.1007/s12471-016-0860-4
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 61, 1173–1182. https://doi.org/10.1037//0022-3514.51.6.1173
Baysak, S., Kılıç, F. A., Karagün, E., & Baysak, E. (2020). Relationship of alexithymia, rumination and coping style with psoriasis and their effects on the clinical features. Türk Psikiyatri Dergisi, 31(4), 252–258. https://doi.org/10.5080/u23743
Booth, L., & Williams, L. (2015). Type D personality and dietary intake: The mediating effects of coping style. Journal of Health Psychology, 20(6), 921–927. https://doi.org/10.1177/1359105315573433
Borkoles, E., Kaiseler, M., Evans, A., Ski, C. F., Thompson, D. R., & Polman, R. C. (2018). Type D personality, stress, coping and performance on a novel sport task. PloS One, 13(4), e0196692. https://doi.org/10.1371/journal.pone.0196692
Bransfield, R. C., & Friedman, K. J. (2019). Differentiating psychosomatic, somatopsychic, multisystem illnesses and medical uncertainty. Healthcare, 7(4), 114. https://doi.org/10.3390/healthcare7040114
Clark, D. M. (1988). A cognitive model of panic attacks. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 71–89). Lawrence Erlbaum Associates.
Compare, A., Germani, E., Proietti, R., & Janeway, D. (2011). Clinical psychology and cardiovascular disease: An up-to-date clinical practice review for assessment and treatment of anxiety and depression. Clinical Practice & Epidemiology in Mental Health, 7, 148–156. https://doi.org/10.2174/1745017901107010148
Conversano, C. (2019). Common psychological factors in chronic diseases. Frontiers in Psychology, 10, 2727. https://doi.org/10.3389/fpsyg.2019.02727
Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67(1), 89–97. https://doi.org/10.1097/01.psy.0000149256.81953.49
Denollet, J. (2012). Type D or not type D: That's the question. The European Health Psychologist, 14(3), 58–63. https://doi.org/10.1037/e544782013-003
Denollet, J., & Pedersen, S. S. (2009). Anger, depression and anxiety in cardiac patients: The complexity of individual differences in psychological risk. Journal of the American College of Cardiology, 53, 947–949. https://doi.org/10.1016/j.jacc.2008.12.006
Denollet, J., Schiffer, A. A., & Spek, V. (2010). A general propensity to psychological distress affects cardiovascular outcomes: Evidence from research on the type D (distressed) personality profile. Circulation: Cardiovascular Quality and Outcomes, 3(5), 546–557. https://doi.org/10.1161/CIRCOUTCOMES.109.934406
Doyle, F., McGee, H., Delaney, M., Motterlini, N., & Conroy, R. (2011). Depressive vulnerabilities predict depression status and trajectories of depression over 1 year in persons with acute coronary syndrome. General Hospital Psychiatry, 33(3), 224–231. https://doi.org/10.1016/j.genhosppsych.2011.03.008
Eifert, G. H., Hodson, S. E., Tracey, D. R., Seville, J. L., & Gunawardane, K. (1996). Heart-focused anxiety, illness beliefs, and behavioral impairment: Comparing healthy heart-anxious patients with cardiac and surgical inpatients. Journal of Behavioral Medicine, 19, 385–399. https://doi.org/10.1007/BF01904764
Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W., & Davig, J. (2000). The Cardiac Anxiety Questionnaire: Development and preliminary validity. Behaviour Research and Therapy, 38, 1039–1053. https://doi.org/10.1016/S0005-7967(99)00132-1
Eifert, G. H., Zvolensky, M. J., Sorrell, J. T., Hopko, D. R., & Lejuez, C. W. (1999). Predictors of self-reported anxiety and panic symptoms: An evaluation of anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Journal of Psychopathology and Behavioral Assessment, 21, 293–305. https://doi.org/10.1023/A:1022116731279
Grande, G., Romppel, M., & Barth, J. (2012). Association between type D personality and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Annals of Behavioral Medicine, 43(3), 299–310. https://doi:10.1007/s12160-011-9339-0
Hamang, A., Eide, G. E., Rokne, B., Nordin, K., & Øyen, N. (2011). General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety – a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death. Health and Quality of Life Outcomes, 9, 100–109. https://doi.org/10.1186/1477-7525-9-100
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
Hirani, S. P., & Newman, S. P. (2005). Patients' beliefs about their cardiovascular disease. Heart, 91, 1235–1239. https://doi.org/10.1136/hrt.2003.025262
Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65, 599–610. https://doi.org/10.1037/0022-006X.65.4.599
Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. https://doi.org/10.1093/jpepsy/27.1.87
Horsten, M., Mittleman, M. A., Wamala, S. P., Schenck-Gustafsson, K., & Orth-Gomer, K. (2000). Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study. European Heart Journal, 21(13), 1072–1080. https://doi.org/10.1053/euhj.1999.2012
Hoyer, J., Eifert, G. H., Einsle, F., Zimmermann, K., Krauss, S., Knaut, M., Matschke, K., & Köllner, V. (2008). Heart-focused anxiety before and after cardiac surgery. Journal of Psychosomatic Research, 64, 291–297. https://doi.org/10.1016/j.jpsychores.2007.09.009
Hrvatski zavod za javno zdravstvo [Croatian Institute of Public Health] (2019). Svjetski dan srca 2019. [2019 World Heart Day]. Retrieved from https://www.hzjz.hr/sluzba-epidemiologija-prevencija-nezaraznih-bolesti/svjetski-dan-srca-2019/
IBM Corp. (2017). IBM SPSS Statistics for Windows, Version 25.0. IBM Corp.
Johnson, J. L., & Morse, J. M. (1990). Regaining control: The process of adjustment after myocardial infarction. Heart & Lung: The Journal of Critical Care, 19, 126–135.
Johnson, L. H., & Roberts, S. L. (1996). A cognitive model for assessing depression and providing nursing interventions in cardiac intensive care. Intensive and Critical Care Nursing, 12(3), 138–146. https://doi.org/10.1016/s0964-3397(96)80452-6
Kapfhammer, H. P. (2011). The relationship between depression, anxiety and heart disease - a psychosomatic challenge. Psychiatria Danubina, 23(4), 412–424. PMID: 22075746.
Kano, M., Endo, Y., & Fukudo, S. (2018). Association between alexithymia and functional gastrointestinal disorders. Frontiers in Psychology, 9, 599. https://doi.org/10.3389/fpsyg.2018.00599
Kano, M., Muratsubaki, T., Yagihashi, M., Morishita, J., Mugikura, S., Dupont, P., Takase, K., Kanazawa, M., Van Oudenhove, L., & Fukudo, S. (2020). Insula activity to visceral stimulation and endocrine stress responses as associated with alexithymia in patients with irritable bowel syndrome. Psychosomatic Medicine, 82(1), 29–38. https://doi.org/10.1097/PSY.0000000000000729
Kessing, D., Denollet, J., Widdershoven, J., & Kupper, N. (2016). Psychological determinants of heart failure self-care: Systematic review and meta-analysis. Psychosomatic Medicine, 78(4), 412–431. https://doi.org/10.1097/PSY.0000000000000270
Kim, Y. H., Kim, S. R., Kim, Y. O., Kim, J. Y., Kim, H. K., & Kim, H. Y. (2017). Influence of type D personality on job stress and job satisfaction in clinical nurses: The mediating effects of compassion fatigue, burnout, and compassion satisfaction. Journal of Advanced Nursing, 73(4), 905–916. https://doi.org/10.1111/jan.13177
Kupper, N., Boomsma, D. I., de Geus, E. J., Denollet, J., & Willemsen, G. (2011). Nine-year stability of type D personality: Contributions of genes and environment. Psychosomatic Medicine, 73(1), 75–82. https://doi.org/10.1097/PSY.0b013e3181fdce54
Kupper, N., & Denollet, J. (2018). Type D personality as a risk factor in coronary heart disease: A review of current evidence. Current cardiology reports, 20, 104. https://doi.org/10.1007/s11886-018-1048-x
Lambertus, F., Herrmann-Lingen, C., Fritzsche, K., Hamacher, S., Hellmich, M., Jünger, J., Ladwig, K.-H., Michal, M., Ronel, J., Schultz, J.-H., Vitinius, F., Weber, C., & Albus, C. (2018). Prevalence of mental disorders among depressed coronary patients with and without Type D personality. Results of the multi-center SPIRR-CAD trial. General Hospital Psychiatry, 50, 69–75. https://doi.org/10.1016/j.genhosppsych.2017.10.001
Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 143–163.
https://doi.org/10.1007/BF01173486
Lynch, P., & Stevens, M. N. (1985). Depression and the physically ill. In C. Rogers C & J. Van Lanen (Eds.), Nursing interventions in depression (pp. 53–69). Grune and Stratton.
MacKinnon, D. P., & Dwyer, J. H. (1993). Estimating mediated effects in prevention studies. Evaluation Review, 17, 144–158. https://doi.org/10.1177/0193841X9301700202
Marchi, L., Marzetti, F., Orrù, G., Lemmetti, S., Miccoli, M., Ciacchini, R., Hitchcott, P. K., Bazzicchi, L., Gemignani, A., & Conversano, C. (2019). Alexithymia and psychological distress in patients with fibromyalgia and rheumatic disease. Frontiers in Psychology, 10, 1735. https://doi.org/10.3389/fpsyg.2019.01735
Marker, C. D., Carmin, C. N., & Ownby, R. L. (2008). Cardiac anxiety in people with and without coronary atherosclerosis. Depression and Anxiety, 25, 824–831. https://doi.org/10.1002/da.20348
Martino, G., Bellone, F., Langher, V., Caputo, A., Catalano, A., Quattropani, M. C., & Morabito, N. (2019a). Alexithymia and psychological distress affect perceived quality of life in patients with type 2 diabetes mellitus. Mediterranean Journal of Clinical Psychology, 7(3). https://doi.org/10.6092/2282-1619/2019.7.2328
Martino, G., Catalano, A., Bellone, F., Russo, G. T., Vicario, C. M., Lasco, A., Quattropani, M. C., & Morabito, N. (2019b). As time goes by: Anxiety negatively affects the perceived quality of life in patients with type 2 diabetes of long duration. Frontiers in Psychology, 10, 1779. https://doi.org/10.3389/fpsyg.2019.01779
Morgan, K., Villiers-Tuthill, A., Barker, M., & McGee, H. (2014). The contribution of illness perception to psychological distress in heart failure patients. BMC Psychology, 2, 50. https://doi.org/10.1186/s40359-014-0050-3
Moser, D. K., Dracup, K., Evangelista, L. S., Zambroski, C. H., Lennie, T. A., Chung, M. L., Doering, L. V., Westlake, C., & Heo, S. (2010). Comparison of prevalence of symptoms of depression, anxiety and hostility in elderly heart failure, myocardial infarction and coronary artery bypass graft patients. Heart & Lung: The Journal of Critical Care, 39(5), 378–385. https://doi.org/10.1016/j.hrtlng.2009.10.017
Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health, 17, 1–16. https://doi.org/10.1080/08870440290001494
Muschalla, B., Glatz, J., & Linden, M. (2014). Heart-related anxieties in relation to general anxiety and severity of illness in cardiology patients. Psychology, Health & Medicine, 19, 83–92. https://doi.org/10.1080/13548506.2013.774428
Myles, L. A. M., & Merlo, E. M. (2021). Alexithymia and physical outcomes in psychosomatic subjects: A cross-sectional study. Journal of Mind and Medical Sciences, 8(1), 86–93. https://doi.org/10.22543/7674.81.P8693
Panzaru, G. M., & Holman, A. (2015). Type of treatment of cardiac disorders – quality of life and heart-focused anxiety: The mediating role of illness perceptions. Psychology, Health & Medicine, 20, 551–559. https://doi.org/10.1080/13548506.2014.989863
Pedersen, S. S., & Denollet, J. (2006). Is Type D personality here to stay? Emerging evidence across cardiovascular disease patient groups. Current Cardiology Reviews, 2(3), 205–213. https://doi.org/10.2174/157340306778019441
Pedersen, S. S., Von Känel, R., Tully, P. J., & Denollet, J. (2017). Psychosocial perspectives in cardiovascular disease. European Journal of Preventive Cardiology, 24(3_suppl), 108–115. https://doi.org/10.1177/2047487317703827
Petrie, K. J., Jago, L. A., & Devcich, D. A. (2007). The role of illness perceptions in patients with medical conditions. Current Opinion in Psychiatry, 20, 163–167. https://doi.org/10.1097/YCO.0b013e328014a871
Petrie, K. J., & Weinman, J. (2006). Why illness perceptions matter. Clinical Medicine, 6, 536–539.
https://doi.org/10.7861/clinmedicine.6-6-536
Pokrajac-Bulian, A., & Ambrosi-Randić, N. (2020). Illness perception in overweight and obese patients with cardiovascular diseases. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 25(1), 69–78. https://doi.org/10.1007/s40519-018-0506-1
Rapee, R., & Medoro, L. (1994). Fear of physical sensations and trait anxiety as mediators of the response to hyperventilation in nonclinical subjects. Journal of Abnormal Psychology, 103(4), 693–699. https://doi.org/10.1037/0021-843X.103.4.693
Rief, W., & Broadbent, E. (2007). Explaining medically unexplained symptoms – models and mechanisms. Clinical Psychology Review, 27, 821–841. https://doi.org/10.1016/j.cpr.2007.07.005
Rosman, L., Whited, A., Lampert, R., Mosesso, V. N., Lawless, C., & Sears, S. F. (2015). Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications. International Journal of Cardiology, 181, 73–76. https://doi.org/10.1016/j.ijcard.2014.11.115
Sheikh, S., Dahiya, S., Ansari, A. H., & Kumar, M. M. (2019). The association of quality of life between anxiety and depression in patients with chronic rheumatic heart disease. Mediterranean Journal of Clinical Psychology, 7(2). https://doi.org/10.6092/2282-1619/2019.7.2164
Shen, B. J., Avivi, Y. E., Todaro, J. F., Spiro, A., Laurenceau, J. P., Ward, K. D., & Niaura, R. (2008). Anxiety characteristics independently and prospectively predict myocardial infarction in men: The unique contribution of anxiety among psychologic factors. Journal of the American College of Cardiology, 51(2), 113–119. https://doi.org/10.1016/j.jacc.2007.09.033
Sprangers, M. A., de Regt, E. B., Andries, F., van Agt, H. M., Bijl, R. V., de Boer, J. B., Foets, M., Hoeymans, N., Jacobs, A. E., Kempen, G. I., Miedema, H. S., Tijhuis, M. A. R., & de Haes, H. C. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53(9), 895–907. https://doi.org/10.1016/S0895-4356(00)00204-3
Staniute, M., Brozaitiene, J., Burkauskas, J., Kazukauskiene, N., Mickuviene, N., & Bunevicius, R. (2015). Type D personality, mental distress, social support and health-related quality of life in coronary artery disease patients with heart failure: A longitudinal observational study. Health and Quality of Life Outcomes, 13(1). https://doi.org/10.1186/s12955-014-0204-2
Starrenburg, A. H., Kraaier, K., Pedersen, S. S., van Hout, M., Scholten, M., & van der Palen, J. (2013). Association of psychiatric history and type D personality with symptoms of anxiety, depression, and health status prior to ICD implantation. International Journal of Behavioral Medicine, 20(3), 425–433. https://doi.org/10.1007/s12529-012-9244-3
Suciu, M., & Cristescu, C. (2017). Psychosomatic interrelations in cardiovascular diseases and their consequences on patient’s quality of life. In M. Mollaoğlu (Eds.), Well-being and quality of life - Medical perspective (pp. 79–112). IntechOpen. http://dx.doi.org/10.5772/intechopen.69699
Taylor, S., & Cox, B. J. (1998). Anxiety sensitivity: Multiple dimensions and hierarchic structure. Behaviour Research and Therapy, 36, 37–51. https://doi.org/10.1016/S0005-7967(97)00071-5
Thombs, B. D., Bass, E. B., Ford, D. E., Stewart, K. J., Tsilidis, K. K., Patel, U., Fauerbach, J. A., Bush, D. E., & Ziegelstein, R. C. (2006). Prevalence of depression in survivors of acute myocardial infarction. Journal of General Internal Medicine, 21, 30–38. https://doi.org/10.1111/j.1525-1497.2005.00269.x
World Health Organization (WHO) (2021). Cardiovascular diseases (CVDs). https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Zhong, L., & Zhou, X. Y. (2021). Application progress of cognitive behavioral therapy in coronary heart disease. TMR Integrative Nursing, 5(5), 160–162. https://doi.org/10.53388/TMRIN2021160162
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
DOI: https://doi.org/10.13129/2282-1619/mjcp-3374
Refbacks
- There are currently no refbacks.