Predicting Depression from Illness Severity in Cardiovascular Disease Patients: Self-efficacy Beliefs, Illness Perception, and Perceived Social Support as Mediators
Many studies have investigated the relationships between cardiovascular diseases and patients’ depression; nevertheless, few is still known as regard the impact of illness severity on depression and whether psychosocial variables mediate this association.
The aim of this study is to investigate the putative mediating role of illness representations, self-efficacy beliefs, and perceived social support on the relationship between illness severity and depression.
A total of 75 consecutive patients with cardiovascular disease (80 % men; mean age = 65.44, SD = 10.20) were enrolled in an Italian hospital. Illness severity was measured in terms of left ventricular ejection fraction, whereas psychological factors were assessed using self-report questionnaires.
The relationship between left ventricular ejection fraction and depression was mediated by identity illness perception, self-efficacy beliefs in managing cardiac risk factors, and perceived social support.
The treatment of depression in cardiovascular disease patients may therefore benefit from a psychological intervention focused on patients’ illness representations, self-efficacy beliefs, and their perceived social support.
KeywordsDepression Cardiovascular disease severity Self-efficacy beliefs Illness perception Perceived social support
- 7.de Leon CF M, Krumholz HM, Seeman TS, Vaccarino V, Williams CS, Kasl SV, et al. Depression and risk of coronary heart disease in elderly men and women: New Haven EPESE, 1982–1991. Established Populations for the Epidemiologic Studies of the Elderly. Arch Intern Med. 1998;158:2341–8.CrossRefGoogle Scholar
- 11.Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, et al. Depression and coronary heart disease. Recommendations for screening, referral, and treatment. A science advisory from the American heart association prevention committee of the council on cardiovascular nursing, council on clinical cardiology, council on epidemiology and prevention, and interdisciplinary council on quality of care and outcomes research. Circulation. 2008;118:1768–75.PubMedCrossRefGoogle Scholar
- 19.Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: fourth joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiov Prev R. 2007;28:2375–414.Google Scholar
- 20.Sommaruga M, Tramarin R, Angelino E, Bettinardi O, Cauteruccio MA, Miglioretti M, et al. Guidelines for psychology activities in cardiac rehabilitation and prevention. Task Force for Psychology Activities in Cardiac Rehabilitation and Prevention Italian Working Group on Cardiac Rehabilitation and Prevention (GICR). Monaldi Arch Chest Dis. 2003;60:184–234.Google Scholar
- 21.Leventhal H, Nerenz DR, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health: social psychological aspects of health. Hillsdale, NJ: Erlbaum; 1984. p. 219–52.Google Scholar
- 22.Leventhal H, Leventhal EA, Cameron L. Representations, procedures, and affect in illness self-regulation: a perceptual-cognitive model. In: Baum AS, Revenson TA, Singer JE, editors. Handbook of health psychology. New York, NY: Erlbaum; 2001. p. 19–48.Google Scholar
- 23.Scharloo M, Kaptein A. Measurement of illness perceptions in patients with chronic somatic illness: a review. In: Petrie KJ, Weinman JA, editors. Perceptions of Health and Illness: Current Research and Applications. New York, NY: Routledge; 1997. p. 103–54.Google Scholar
- 34.Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1997;84:191–215.Google Scholar
- 35.Bandura A. Self-efficacy: the exercise of control. New York, NY: Freeman; 1997.Google Scholar
- 36.Bandura A. Health promotion from the perspective of social cognitive theory. In: Norman P, Abraham CA, Conner M, editors. Understanding and changing health behaviour: from health beliefs to self-regulation. Amsterdam: Harwood Academic; 2000. p. 299–339.Google Scholar
- 39.Schwarzer R. Self-efficacy: thought control of action. Washington, DC: Hemisphere; 1992.Google Scholar
- 51.Schwarzer R, Knoll N. Social support. In: French D, Kaptein A, Vedhara K, Weinman J, editors. Health psychology. 2nd ed. Oxford: Wiley-Blackwell; 2010. p. 283–93.Google Scholar
- 53.Weir RAP, Martin TN, Murphy CA, Petrie CJ, Clements S, Steedman T, et al. Comparison of serial measurements of infarct size and left ventricular ejection fraction by contrast-enhanced cardiac magnetic resonance imaging and electrocardiographic QRS scoring in reperfused anterior ST-elevation myocardial infarction. J Electrocardiol. 2010;43:230–6.PubMedCrossRefGoogle Scholar
- 56.Volpi A, De Vita C, Franzosi MG, Geraci E, Maggioni AP, Mauri F, et al. Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis. Results of the GISSI-2 data base. The Ad hoc Working Group of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-2 Data Base. Circulation. 1993;88:416–29.PubMedCrossRefGoogle Scholar
- 58.Pain D, Miglioretti M, Angelino E. Sviluppo della versione italiana del Brief-IPQ, strumento psicometrico per lo studio delle rappresentazioni di malattia. Psicologia della Salute. 2006;1:81–9.Google Scholar
- 61.Carver CS. Sources of Social Support Scale. 2006. http://www.psy.miami.edu/faculty/ccarver/sclSSSS.html.
- 62.Wortman CB, Conway TL. The role of social support in adaption and recovery from illness. In: Cohen S, Syme SL, editors. Social Support and Health. Orlando: Academic Press Inc; 1985. p. 281–302.Google Scholar
- 63.Dunbar-Jacob J, Dwyer K, Dunning EJ. Compliance with antihypertensive regimen: a review of the research in the 1980s. Ann Behav Med. 1991;13:31–9.Google Scholar
- 65.Sanavio E, Bertolotti G, Michielin P, Vidotto G, Zotti AM. CBA-2.0. Cognitive Behavioural Assessment 2.0. Scale primarie. Firenze: Organizzazioni Speciali; 1997.Google Scholar
- 66.Muthén LK, Muthén BO. Mplus User’s guide. 6th edition. Los Angeles, CA: Muthén & Muthén; 1998–2010. http://www.statmodel.com/download/usersguide/Mplus%20Users%20Guide%20v6.pdf.
- 67.West SG, Finch JF, Curran PJ. Structural equation models with nonnormal variables: problems and remedies. In: Hoyle RH, editor. Structural equation modeling: issues, concepts, and applications. Thousand Oaks, CA: Sage; 1995. p. 56–75.Google Scholar
- 71.Steca P, Greco A, Monzani D, Politi A, Gestra R, Ferrari G, et al. How Does Illness Severity Influence Depression, Health Satisfaction, and Life Satisfaction in Patients with Cardiovascular Disease? The Mediating Role of Illness Perception and Self-efficacy Beliefs. Psychol Health. 2013. doi: 10.1080/08870446.2012.759223.
- 72.Steca P, Greco A, D’Addario M, Monzani D, Pozzi R, Villani A, et al. Relationship of illness severity with health and life satisfaction in patients with cardiovascular disease: The mediating role of self-efficacy beliefs and illness perception. J Happiness Stud. 2012. doi: 10.1007/s10902-012-9397-4.
- 75.Ewart CK. The role of physical self-efficacy in recovery from heart attack. In: Schwarzer R, editor. Self-Efficacy: Thought Control of Action. Washington, DC: Hemisphere; 1992. p. 287–304.Google Scholar
- 78.Chesney M, Darbes L. Social support and heart disease in women: implications for intervention. In: Orth-Gomér K, Chesney M, Wenger NK, editors. Women, stress and heart disease. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 1998. p. 165–82.Google Scholar