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Predicting Depression from Illness Severity in Cardiovascular Disease Patients: Self-efficacy Beliefs, Illness Perception, and Perceived Social Support as Mediators

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Abstract

Background

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.

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Goldston K, Baillie AJ. Depression and coronary heart disease: a review of the epidemiological evidence, explanatory mechanisms and management approaches. Clin Psychol Rev. 2008;28:288–306.

    Article  PubMed  Google Scholar 

  2. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med. 2002;2:267–314.

    Article  PubMed  Google Scholar 

  3. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45:637–51.

    Article  PubMed  Google Scholar 

  4. Rugulies R. Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med. 2002;23:51–61.

    Article  PubMed  Google Scholar 

  5. Wassertheil-Smoller S, Applegate WB, Berge K, Chang CJ, Davis BR, Grimm R, et al. Change in depression as a precursor of cardiovascular events. Arch Intern Med. 1996;156:553–61.

    Article  PubMed  CAS  Google Scholar 

  6. Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Arch Intern Med. 2000;160:1261–8.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  8. Bunker SJ, Colquhoun DM, Esler MD, Hickie IB, Hunt D, Jelinek VM, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Australia. 2003;178:272–6.

    PubMed  Google Scholar 

  9. Krantz DS, McConey MK. Effect of psychological and social factors on organic disease: a critical assessment of the research on coronary heart disease. Annu Rev Psychol. 2002;53:341–69.

    Article  PubMed  Google Scholar 

  10. Lesperance F, Frasure-Smith N. Depression in patients with cardiac disease: the role of psychosomatic medicine. J Psychosom Res. 2000;48:379–92.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google Scholar 

  12. Frasure-Smith N, Lespérance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA. 1993;270:1819–25.

    Article  PubMed  CAS  Google Scholar 

  13. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1995;91:999–1005.

    Article  PubMed  CAS  Google Scholar 

  14. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66:802–13.

    Article  PubMed  Google Scholar 

  15. Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004;6:305–15.

    Article  Google Scholar 

  16. van Melle J, de Jonge P, Spijkerman T, Tijssen J, Ormel J, van Veldhuisen D, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2004;66:814–22.

    Article  PubMed  Google Scholar 

  17. van Melle JP, de Jonge P, Ormel J, Crijns HJ, van Veldhuisen DJ, Honig A, et al. MIND-IT investigators. Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MINDIT. Eur Heart J. 2005;26:2650–6.

    Article  PubMed  Google Scholar 

  18. Doyle F, Conroy RM, McGee HM, Delaney MK. Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis. J Psychosom Res. 2010;68:121–30.

    Article  PubMed  Google 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 

  24. Jensen MP, Turner JA, Romano JM. Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psych. 1994;62:172–9.

    Article  CAS  Google Scholar 

  25. Petrie KJ, Weinman J, Sharpe N, Buckley J. Role of patients’ view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. Brit Med J. 1996;312:1191–4.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  26. Johnson JA, King KB. Influence of expectation about symptoms on delay in seeking treatment during myocardial infarction. Am J Crit Care. 1995;4:29–35.

    PubMed  CAS  Google Scholar 

  27. Lau-Walker M. Relationship between illness representation and self-efficacy. J Adv Nurs. 2004;48:216–25.

    Article  PubMed  Google Scholar 

  28. Lau-Walker M. Importance of illness beliefs and self-efficacy for patients with coronary heart disease. J Adv Nurs. 2007;60:187–98.

    Article  PubMed  Google Scholar 

  29. French DP, Cooper A, Weinman J. Illness perceptions predict attendance at cardiac rehabilitation following acute myocardial infarction: a systematic review with meta-analysis. J Psychosom Res. 2006;61:757–67.

    Article  PubMed  Google Scholar 

  30. Petrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical illness. Curr Opin Psychiatr. 2007;20:163–7.

    Article  Google Scholar 

  31. Cherrington CC, Moser DK, Lennie TA, Kennedy CW. Illness representation after acute myocardial infarction: impact on in-hospital recovery. Am J Crit Care. 2004;13:136–45.

    PubMed  Google Scholar 

  32. Whitmarsh A, Koutantji M, Sidell K. Illness perceptions, mood and coping in predicting attendance at cardiac rehabilitation. Brit J Health Psych. 2003;8:209–21.

    Article  Google Scholar 

  33. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60:631–7.

    Article  PubMed  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 

  37. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31:143–64.

    Article  PubMed  Google Scholar 

  38. Aljasem L, Peyrot M, Wissow L, Rubin R. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educator. 2001;27:393–404.

    Article  PubMed  CAS  Google Scholar 

  39. Schwarzer R. Self-efficacy: thought control of action. Washington, DC: Hemisphere; 1992.

    Google Scholar 

  40. Arnold R, Ranchor AV, DeJongste MJ, Köeter GH, Ten Hacken NH, Aalbers R, et al. The relationship between self-efficacy and self-reported physical functioning in chronic obstructive pulmonary disease and chronic heart failure. Behav Med. 2005;31:107–15.

    Article  PubMed  Google Scholar 

  41. Carlson JJ, Norman GJ, Feltz DL, Franklin BA, Johnson JA, Locke SK. Self-efficacy, psychosocial factors, and exercise behavior in traditional versus modified cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2001;21:363–73.

    Article  CAS  Google Scholar 

  42. Izawa KP, Watanabe S, Omiya K, Hirano Y, Oka K, Osada N, et al. Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial. Am J Phys Med Rehab. 2005;84:313–21.

    Article  Google Scholar 

  43. Sarkar U, Ali S, Whooley MA. Self-efficacy and health status in patients with coronary heart disease: findings from the heart and soul study. Psychosom Med. 2007;69:306–12.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Sarkar U, Ali S, Whooley MA. Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: findings from the Heart and Soul Study. Health Psychol. 2009;28:166–73.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Heijmans M, de Ridder D. Assessing illness representations of chronic illness: explorations of their disease-specific nature. J Behav Med. 1998;21:485–503.

    Article  PubMed  CAS  Google Scholar 

  46. Kurlowicz LH. Perceived self-efficacy, functional ability, and depressive symptoms in older surgery patients. Nurs Res. 1998;47:219–26.

    Article  PubMed  CAS  Google Scholar 

  47. Tsay SL, Chao YF. Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure. JNR. 2002;10:271–8.

    Article  PubMed  Google Scholar 

  48. Oxman TE, Hull JG. Social support, depression, and activities of daily living in older heart surgery patients. J Gerontol. 1997;52:1–14.

    Article  Google Scholar 

  49. Brummett BH, Babyak MA, Barefoot JC, Bosworth HB, Clapp-Channing NE, Siegler IC, et al. Social support and hostility as predictors of depressive symptoms in cardiac patients one month following hospitalization: a prospective study. Psychosom Med. 1998;60:707–13.

    PubMed  CAS  Google Scholar 

  50. Frasure-Smith N, Lespérance F, Ginette G, Masson A, Juneau M, Talajic M, et al. Social support, depression, and mortality during the first year after myocardial infarction. Circulation. 2000;101:1919–24.

    Article  PubMed  CAS  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 

  52. Brummett BH, Mark DB, Siegler I, Williams RB, Babyak MA, Clapp-Channing NE, et al. Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosom Med. 2005;67:40–5.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  54. Eichhorn EJ. Prognosis determination in heart failure. Am J Med. 2001;110(7A):14S–36S.

    Article  PubMed  Google Scholar 

  55. Clayton TC, Lubsen J, Pocock SJ, Vokó Z, Kirwan BA, Fox KA, et al. Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients. Brit Med J. 2005;331:869–72.

    Article  PubMed Central  PubMed  Google 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.

    Article  PubMed  CAS  Google Scholar 

  57. Costanzo MR, Augustine S, Bourge R, Bristow N, O’Connell JB, Driscoll D, et al. Selection and treatment of candidates for heart transplantation. Circulation. 1995;92(12):3593–612.

    Article  PubMed  CAS  Google 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 

  59. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Heal. 2002;17:1–16.

    Article  Google Scholar 

  60. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.

    Article  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 

  64. Morisky DE, DeMuth NM, Field-Fass M, Green LW, Levine DM. Family social support and long-term control of high blood pressure. Health Educ Quart. 1985;12:35–50.

    Article  CAS  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.

  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 

  68. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999;6:1–55.

    Article  Google Scholar 

  69. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Re Methods. 2008;40:879–91.

    Article  Google Scholar 

  70. Ladwig KH, Kieser M, Konig J, Breithardt G, Borggreffe M. Affective disorders and survival after acute myocardial infarction. Eur Heart J. 1991;12:959–64.

    PubMed  CAS  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.

  73. Diedericks JPM, Bar FW, Hoppener P, Vonken H, Appels A, Wellens HJJ. Predictors of return to former leisure and social activities in MI patients. J Psychosom Res. 1991;35:687–96.

    Article  Google Scholar 

  74. Dusseldorp E, van Elderen T, Maes S, Meulman J, Kraaij V. A meta-analysis of psychoeductional programs for coronary heart disease patients. Health Psychol. 1999;18:506–19.

    Article  PubMed  CAS  Google Scholar 

  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 

  76. Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions following myocardial infarction: an early intervention randomized controlled trial. Psychosom Med. 2002;64:580–6.

    PubMed  Google Scholar 

  77. Jeng C, Braun LT. The influence of self-efficacy on exercise intensity, compliance rate and cardiac rehabilitation outcomes among coronary artery disease patients. Prog Cardiovasc Nurs. 1997;12:13–24.

    PubMed  CAS  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 

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Authors and Affiliations

  1. Department of Psychology, University of Milan “Bicocca”, Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy

    A. Greco, P. Steca, D. Monzani & M. D’Addario

  2. Faculty of Medicine, University of Milan, Milan, Italy

    R. Pozzi

  3. Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, Milan, Italy

    A. Villani, V. Rella, A. Giglio, G. Malfatto & G. Parati

  4. Department of Clinical Medicine and Prevention, University of Milan “Bicocca”, Milan, Italy

    G. Parati

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  1. A. Greco
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  2. P. Steca
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  3. R. Pozzi
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  4. D. Monzani
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  5. M. D’Addario
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  6. A. Villani
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Correspondence to A. Greco.

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Greco, A., Steca, P., Pozzi, R. et al. Predicting Depression from Illness Severity in Cardiovascular Disease Patients: Self-efficacy Beliefs, Illness Perception, and Perceived Social Support as Mediators. Int.J. Behav. Med. 21, 221–229 (2014). https://doi.org/10.1007/s12529-013-9290-5

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