Heart-Focused Anxiety as a Mediator Between Illness Perception and Negative Affect in Cardiac Patients

Alessandra Pokrajac-Bulian, Miljana Kukić


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.


Illness perceptions; Cardiovascular diseases; Heart-focus anxiety; Depression; Anxiety.

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DOI: https://doi.org/10.13129/2282-1619/mjcp-3374


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