Psychological, Medical and Laboratory Predictors of Cardiac Anxiety in Patients with Heart Failure

Alessandra Pokrajac-Bulian, Teodora Zaninović Jurjević, Štefica Dvornik, Irena Vodopija-Krstanović, Alen Ružić


Objective: The aim of the study was to identify predictors of heart-focused anxiety in patients with heart failure. A better understanding of such predictors may help in detecting the comorbidity underlying heart-focused anxiety and identifying patients who need psychological help.

Methods: In order to account for multiple sources of heart-focused anxiety, we included psychological, lifestyle, and medical/laboratory predictors. The study involved 148 patients, of whom 74 had a leading diagnosis of worsening heart failure and were hospitalized during the COVID-19 epidemic. A second group of 74 patients suffering from cardiovascular diseases without a diagnosis of acute heart failure, were examined in various out-patient cardiology clinics. The sample consisted of 37.8% females and 62.2% males, with an average age of 63.35 years. The patients completed the Cardiac Anxiety Questionnaire, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Intolerance of Uncertainty Scale.

Results: Patients with heart failure with higher levels of depression and intolerance of uncertainty had higher overall levels of heart-focused anxiety, higher levels of fear about chest and heart sensations. Older patients with higher levels of depression had higher levels of activity avoidance, especially activities believed to elicit cardiac symptoms. Cardiac patients with higher level of anxiety and with anaemia as comorbidity had higher levels of heart-focused attention and monitoring of cardiac activity.

Conclusion: In patients with heart failure, the presence of heart-focused anxiety significantly reduces the quality of life, leads to avoidant behaviours, and is associated with anxiety and depressive symptoms. These patients are more likely to seek medical help and specialist services, but the need for psychological help is very rarely recognized.


Heart failure; Heart-focused anxiety; Anaemia; Anxiety; Depression; Intolerance of uncertainty.

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Aggelopoulpou, Z., Fotos, N. V., Chatziefstratiou, A. A., Giakoumidakis, K., Elefsiniotis, I., & Brokalaki, H. (2017). The level of anxiety, depression and quality of life among patients with heart failure in Greece. Applied Nursing Research, 34, 52–56.

Aikens, J. E., Zvolensky, M. J., & Eifert, G. H. (2001). Differential Fear of Cardiopulmonary Sensations in Emergency Room Noncardiac Chest Pain Patients. Journal of Behavioral Medicine, 24(2), 155–167.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011–1023.

Borkoles, E., Kaiseler, M., Evans, A., Ski, C. F., Thompson, D. R., & Polman, R. C. J. (2018). Type D personality, stress, coping and performance on a novel sport task. PLoS ONE, 13(4), e0196692.

Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931–945.

Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 8(1), 30–41.

Bunz, M., Lenski, D., Wedegärtner, S., Ukena, C., Karbach, J., Böhm, M., & Kindermann, I. (2016). Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clinical Research in Cardiology, 105(3), 216–224.

Büssing, A., Ostermann, T., Neugebauer, E. A., & Heusser, P. (2010). Adaptive coping strategies in patients with chronic pain conditions and their interpretation of disease. BMC Public Health, 10(1), 1–10.

Cameron, O. G., Abelson, J. L., & Young, E. A. (2004). Anxious and depressive disorders and their comorbidity: Effect on central nervous system noradrenergic function. Biological Psychiatry, 56(11), 875–883.

Caraballo, C., Desai, N. R., Mulder, H., Alhanti, B., Wilson, F. P., Fiuzat, M., Felker, G. M., Piña, I. L., O’Connor, C. M., Lindenfeld, J., Januzzi, J. L., Cohen, L. S., & Ahmad, T. (2019). Clinical Implications of the New York Heart Association Classification. Journal of the American Heart Association, 8(23), e014240.

Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117.

Celano, C. M., Mastromauro, C. A., Lenihan, E. C., Januzzi, J. L., Rollman, B. L., & Huffman, J. C. (2012). Association of baseline anxiety with depression persistence at 6 months in patients with acute cardiac illness. Psychosomatic Medicine, 74(1), 93–99.

Celano, C. M., Millstein, R. A., Bedoya, C. A., Healy, B. C., Roest, A. M., & Huffman, J. C. (2015). Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. American Heart Journal, 170(6), 1105–1115.

Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018a). Depression and Anxiety in Heart Failure: A Review. Harvard Review of Psychiatry, 26(4), 175–184.

Chapa, D. W., Akintade, B., Son, H., Woltz, P., Hunt, D., Friedmann, E., Hartung, M. K., & Thomas, S. A. (2014). Pathophysiological relationships between heart failure and depression and anxiety. Critical Care Nurse, 34(2), 14–25.

Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The Impact of Psychological Interventions on Medical Cost Offset: A Meta-analytic Review. Clinical Psychology: Science and Practice, 6(2), 204–220.

Chopra, V. K., & Anker, S. D. (2020). Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Heart Failure, 7(5), 2007–2011.

Conrad, N., Judge, A., Tran, J., Mohseni, H., Hedgecott, D., Crespillo, A. P., Allison, M., Hemingway, H., Cleland, J. G., McMurray, J. J. V., & Rahimi, K. (2018). Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. The Lancet, 391(10120), 572–580.

Conversano, C., Ciacchini, Ŕ., Orrù, G., Di Giuseppe, M., Gemignani, A., & Poli, A. (2020). Mindfulness, compassion, and self-compassion among health care professionals: What’s new? a systematic review. Frontiers in Psychology, 11, 1683.

Conversano, C., & Di Giuseppe, M. (2021). Psychological factors as determinants of chronic conditions: Clinical and psychodynamic advances. Frontiers in Psychology, 12, 635708.

D’Antoni, F. (2021). Brainspotting reduces disturbance and increases Heart Rate Variability linked to distressing memories: A pilot study. Mediterranean Journal of Clinical Psychology, 9(3), 1–24.

Daskalopoulou, M., George, J., Walters, K., Osborn, D. P., Batty, G. D., Stogiannis, D., Rapsomaniki, E., Pujades-Rodriguez, M., Denaxas, S., Udumyan, R., Kivimaki, M., & Hemingway, H. (2016). Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: Data linkage study of 1.9 million women and men. PLoS ONE, 11(4), e0153838.

De Jong, M. J., Moser, D. K., An, K., & Chung, M. L. (2004). Anxiety is not manifested by elevated heart rate and blood pressure in acutely ill cardiac patients. European Journal of Cardiovascular Nursing, 3(3), 247–253.

Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and type D personality. Psychosomatic Medicine, 67(1), 89–97.

Denollet, J., & Brutsaert, D. L. (1998). Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation, 97(2), 167–173.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.

Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of uncertainty and information processing: Evidence of biased recall and interpretations. Cognitive Therapy and Research, 29(1), 57–70.

Ebner, N., Jankowska, E. A., Ponikowski, P., Lainscak, M., Elsner, S., Sliziuk, V., Steinbeck, L., Kube, J., Bekfani, T., Scherbakov, N., Valentova, M., Sandek, A., Doehner, W., Springer, J., Anker, S. D., & Von Haehling, S. (2016). The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the

Studies Investigating Co-morbidities Aggravating Heart Failure. International Journal of Cardiology, 205, 6–12.

Eifert, G. H., & Forsyth, J. P. (1996). Heart-focused and general illness fears in relation to parental medical history and separation experiences. Behaviour Research and Therapy, 34(9), 735–739.

Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W., & Davig, J. (2000a). The Cardiac Anxiety Questionnaire: Development and preliminary validity. Behaviour Research and Therapy, 38(10), 1039–1053.

Eifert, G. H., Zvolensky, M. J., & Lejuez, C. W. (2000b). Heart-Focused Anxiety and Chest Pain: A Conceptual and Clinical Review. Clinical Psychology: Science and Practice, 7(4), 403–417.

Field, A. (2005). Andy Field - Discovering Statistics Using SPSS. In Journal of Advanced Nursing (Vol. 58, Issue 3). sage.

Flouda, E., Stefanatou, A., & Apergi, T. (2021). Intervention options: Depression & Cardiovascular Disease during Covid-19 Pandemia. International Cardiovascular Forum Journal, 21, 7–13.

Fonseca, C. (2017). Comment on “Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review.” Revista Portuguesa de Cardiologia, 36(5), 405–407.

Forte, G., Favieri, F., Oliha, E. O., Marotta, A., & Casagrande, M. (2021). Anxiety and attentional processes: The role of resting heart rate variability. Brain Sciences, 11(4), 480.

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(1), 1–10.

Hamatani, Y., Iguchi, M., Ikeyama, Y., Kunugida, A., Ogawa, M., Yasuda, N., Fujimoto, K., Ichihara, H., Sakai, M., Kinoshita, T., Nakashima, Y., & Akao, M. (2022). Prevalence, Temporal Change, and Determinants of Anxiety and Depression in Hospitalized Patients With Heart Failure. Journal of Cardiac Failure, 28(2), 181–190.

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(3), 291–297.

Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019). Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 73(14), 1827–1845.

Jiang, W., Krishnan, R., Kuchibhatla, M., Cuffe, M. S., Martsberger, C., Arias, R. M., & Oconnor, C. M. (2011). Characteristics of depression remission and its relation with cardiovascular outcome among patients with chronic heart failure (from the SADHART-CHF study). American Journal of Cardiology, 107(4), 545–551.

Jünger, J., Schellberg, D., Müller-Tasch, T., Raupp, G., Zugck, C., Haunstetter, A., Zipfel, S., Herzog, W., & Haass, M. (2005). Depression increasingly predicts mortality in the course of congestive heart failure. European Journal of Heart Failure, 7(2), 261–267.

Kano, M., Endo, Y., & Fukudo, S. (2018). Association between alexithymia and functional gastrointestinal disorders. Frontiers in Psychology, 9(APR), 599.

Kell, E., Wait, S., Harding, E., & Mclister, I. (2015). A policy brief on heart failure in Europe. The Health Policy Partnership, March.

Kraai, I. H., Luttik, M. L. A., Johansson, P., De Jong, R. M., Van Veldhuisen, D. J., Hillege, H. L., & Jaarsma, T. (2012). Health-related quality of life and anemia in hospitalized patients with heart failure. International Journal of Cardiology, 161(3), 151–155.

Kralj, V., & Brkić Biloš, I. (2013). Mortalitet i morbiditet od kardiovaskularnih bolesti. Cardiologia Croatica, 8(10–11), 373–378.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

Kukić, M., & Pokrajac-Bulian, A. (2022). Heart-Focused Anxiety as a Mediator Between Illness Perception and Negative Affect in Cardiac Patients. Mediterranean Journal of Clinical Psychology, 10(1).

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(11), 1–8.

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.

Landolina, M., Gasparini, M., Lunati, M., Santini, M., Rordorf, R., Vincenti, A., Diotallevi, P., Montenero, A. S., Bonanno, C., De Santo, T., Valsecchi, S., & Padeletti, L. (2008). Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure. European Journal of Heart Failure, 10(11), 1073–1079.

Marchi, L., Marzetti, F., Orrù, G., Lemmetti, S., Miccoli, M., Ciacchini, R., Hitchcott, P., Bazzichi, L., Gemignani, A., & Conversano, C. (2019). Alexithymia and psychological distress in patients with fibromyalgia and rheumatic disease. Frontiers in Psychology, 10(JULY), 1735.

Marchini, F., Caputo, A., Napoli, A., Balonan, J. T., Martino, G., Nannini, V., & Langher, V. (2018). Chronic illness as loss of good self: Underlying mechanisms affecting diabetes adaptation. Mediterranean Journal of Clinical Psychology, 6(3), 1–25.

Martino, G., Bellone, F., Langher, V., Caputo, A., Catalano, A., Quattropani, M. C., & Morabito, N. (2019). Alexithymia and psychological distress affect perceived quality of life in patients with type 2 diabetes mellitus. Mediterranean Journal of Clinical Psychology, 7(3), 1–15.

Mcdonagh, T. A., Metra, M., Adamo, M., Gardner, R., Baumbach, A., Bo, M., Burri, H., Butler, J., Celutkiene, J., Chioncel, O., Cleland, J. G., Coats, A. J., Crespo-Leiro, M., Farmakis, D., Gilard, M., & Heymans, S. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology ( ESC ). European Heart Journal, 42(36), 3599–3726.

Mensah, G. A., Roth, G. A., & Fuster, V. (2019). The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond. In Journal of the American College of Cardiology (Vol. 74, Issue 20, pp. 2529–2532). American College of Cardiology Foundation Washington, DC.

Merlo, E. M. (2019). Opinion article: The role of psychological features in chronic diseases, advancements and perspectives. Mediterranean Journal of Clinical Psychology, 7(3), 1–5.

Merlo, E. M., Stoian, A. P., Motofei, I. G., & Settineri, S. (2020). Clinical psychological figures in healthcare professionals: Resilience and maladjustment as the “cost of care.” Frontiers in Psychology, 11, 607783.

Moret, C., & Briley, M. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment, 7(SUPPL.), 9–13.

Mourad, G., Strömberg, A., Johansson, P., & Jaarsma, T. (2016). Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. Patient, 9(1), 69–77.

Mukhtar, P. S. (2020). Mental Well-Being of Nursing Staff During the Coronavirus Disease 2019 Outbreak: A Cultural Perspective. Journal of Emergency Nursing, 46(4), 426–427.

Mukhtar, S., & Mukhtar, S. (2020). Mental Health and Psychological Distress in People with Diabetes during COVID-19. Metabolism: Clinical and Experimental, 108.

Notebaert, L., Tilbrook, M., Clarke, P. J. F., & MacLeod, C. (2017). When a Bad Bias Can Be Good: Anxiety-Linked Attentional Bias to Threat in Contexts Where Dangers Can Be Avoided. Clinical Psychological Science, 5(3), 485–496.

Paolillo, S., Scardovi, A. B., & Campodonico, J. (2020). Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation. European Journal of Preventive Cardiology, 27(2_suppl), 27–34.

Pedersen, 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.

Pedersen, S. S., von Känel, R., Tully, P. J., & Denollet, J. (2017). Psychosocial perspectives in cardiovascular disease. European Journal of Preventive Cardiology, 24(3), 108–115.

Pokrajac-Bulian, A., & Ambrosi-Randić, N. (2020). Illness perception in overweight and obese patients with cardiovascular diseases. Eating and Weight Disorders, 25(1), 69–78.

Reeves, G. C., Alhurani, A. S., Frazier, S. K., Watkins, J. F., Lennie, T. A., & Moser, D. K. (2015). The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure. BMJ Open Diabetes Research and Care, 3(1), 371–380.

Rigueira, J., R. Agostinho, J., Aguiar-Ricardo, I., Gonçalves, I., Santos, R., Nunes-Ferreira, A., Rodrigues, T., Cunha, N., André, N. Z., Pires, R., Veiga, F., Mendes Pedro, M., Pinto, F. J., & Brito, D. (2021). Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes. Revista Portuguesa de Cardiologia, 40(8), 547–555.

Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive behavioral treatment for generalized anxiety disorder: From science to practice, Second Edition. In Cognitive Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice, Second Edition. Routledge.

Roest, A. M., Zuidersma, M., & De Jonge, P. (2012). Myocardial infarction and generalised anxiety disorder: 10-Year follow-up. British Journal of Psychiatry, 200(4), 324–329.

Roy, S. S., Foraker, R. E., Girton, R. A., & Mansfield, A. J. (2015). Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. American Journal of Public Health, 105(4), 757–763.

Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in Heart Failure. A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes. Journal of the American College of Cardiology, 48(8), 1527–1537.

Sbolli, M., Fiuzat, M., Cani, D., & O’Connor, C. M. (2020). Depression and heart failure: the lonely comorbidity. European Journal of Heart Failure, 22(11), 2007–2017.

Shah, R., & Agarwal, A. K. (2013). Anemia associated with chronic heart failure: Current concepts. Clinical Interventions in Aging, 8, 111–122.

Shahar, G. (2021). Interdisciplinarity and Integration: An Introduction to the Special Issue on Psychopathology in Medical Settings. Journal of Clinical Psychology in Medical Settings, 28(1), 1–5.

Sheikh, S. 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).

Sherwood, A., Blumenthal, J. A., Hinderliter, A. L., Koch, G. G., Adams, K. F., Dupree, C. S., Bensimhon, D. R., Johnson, K. S., Trivedi, R., Bowers, M., Christenson, R. H., & O’Connor, C. M. (2011). Worsening depressive symptoms are associated with adverse clinical outcomes in patients with heart failure. Journal of the American College of Cardiology, 57(4), 418–423.

Siddique, S. M., Tipton, K., Leas, B., Greysen, S. R., Mull, N. K., Lane-Fall, M., McShea, K., & Tsou, A. Y. (2021). Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Network Open, 4(9), e2125846–e2125846.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

Spitzer, S., Shaikh, M., & Weber, D. (2022). Older Europeans’ health perception and their adaptive behaviour during the COVID-19 pandemic. European Journal of Public Health, 32(2), 322–327.

Tian, C., & Chen, X. (2016). Advances in diagnosis and treatment of acute heart failure; 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Chinese Journal of Emergency Medicine, 25(7), 854–857.

Timmis, A., Vardas, P., Townsend, N., Torbica, A., Katus, H., De Smedt, D., Gale, C. P., Maggioni, A. P., Petersen, S. E., Huculeci, R., Kazakiewicz, D., Rubio, V. de B., Ignatiuk, B., Raisi-Estabragh, Z., Pawlak, A., Karagiannidis, E., Treskes, R., Gaita, D., Beltrame, J. F., … Achenbach, S. (2022). European Society of Cardiology: cardiovascular disease statistics 2021: Executive Summary. European Heart Journal - Quality of Care and Clinical Outcomes, 8(4), 377–382.

Vaccarino, V., Kasl, S. V., Abramson, J., & Krumholz, H. M. (2001). Depressive symptoms and risk of functional decline and death in patients with heart failure. Journal of the American College of Cardiology, 38(1), 199–205.

Van Beek, M. H. C. T., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J. L. M., Speckens, A. E. M., & Oude Voshaar, R. C. (2016). Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. British Journal of Psychiatry, 209(5), 400–406.

Von Haehling, S., Anker, M. S., Jankowska, E. A., Ponikowski, P., & Anker, S. D. (2012). Anemia in chronic heart failure: Can we treat? What to treat? Heart Failure Reviews, 17(2), 203–210.

Wedegärtner, S. M., Schwantke, I., Kindermann, I., & Karbach, J. (2020). Predictors of heart-focused anxiety in patients with stable heart failure. Journal of Affective Disorders, 276, 380–387.

White, K. S., Pardue, C., Ludbrook, P., Sodhi, S., Esmaeeli, A., & Cedars, A. (2016). Cardiac Denial and Psychological Predictors of Cardiac Care Adherence in Adults With Congenital Heart Disease. Behavior Modification, 40(1–2), 29–50.

Wieser, M. J., & Keil, A. (2020). Attentional threat biases and their role in anxiety: A neurophysiological perspective. International Journal of Psychophysiology, 153, 148–158.

World Health Organisation. (2003). The World Health Report 2003 shaping the future. World Health Organization.

Yoo, J., & Ryff, C. D. (2019). Longitudinal Profiles of Psychological Well-Being and Health: Findings From Japan. Frontiers in Psychology, 10, 2746.



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