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Independent and Mediated Contributions of Personality, Coping, Social Support, and Depressive Symptoms to Physical Functioning Outcome Among Patients in Cardiac Rehabilitation

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Abstract

This study examined the direct and mediated contributions of psychosocial variables to posttreatment physical functioning among 142 patients receiving cardiac rehabilitation. Two models were proposed and tested. In the first model, psychosocial factors were correlated and made to predict baseline and 6-week physical functioning. The results showed that after controlling for age, illness severity, baseline physical functioning, and other psychosocial correlates, optimism and social support still significantly predicted better posttreatment physical functioning. In the second model, we explored both the direct and mediational relationships between psychosocial factors and physical health outcomes. Optimism and social support were found to contribute to health outcomes not only directly but also indirectly through the mediation of less engagement in detrimental coping and lower depressive symptoms, whereas hostility and negative coping only predicted outcomes indirectly through mediators. These findings highlighted the importance of addressing psychosocial issues and their interrelationships in cardiac rehabilitation.

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References

  • American Heart Association. (2001). 2001 Heart and Stroke Statistical Update, American Heart Association, Dallas, TX.

    Google Scholar 

  • Barefoot, J. C., Dodge, K. A., Peterson, B. L., Dahlstrom, W. G., and Williams, R. B., Jr. (1989). The Cook-Medley hostility scale: item content and ability to predict survival. Psychosom. Med. 51 (1): 46-57.

    Google Scholar 

  • Barefoot, J. C., Helms, M. J., Mark, D. B., Blumenthal, J. A., Califf, R. M., Haney, T. L., O'Connor, C. M., Siegler, I. C., and Williams, R. B. (1996). Depression and long-term mortality risk in patients with coronary artery disease. Am. J. Cardiol. 78: 613-617.

    Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., and Erbaugh, J. (1961). An inventory for measuring depression. Arch. Gen. Psychiatry, 4: 561-571.

    Google Scholar 

  • Bentler, P. M. (1995). EQS Structural Equations Program Manual. Multivariate Software, Encino, CA.

    Google Scholar 

  • Bentler, P. M., and Weeks, D. G. (1980). Linear structural equations with latent variables. Psychometrika 45: 289-308.

    Google Scholar 

  • Brezinka, V., Dusseldorp, E., and Maes, S. (1998). Gender differences in psychosocial profile at entry into cardiac rehabilitation. J. Cardiopulmon. Rehabil. 18 (6): 445-449.

    Google Scholar 

  • Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the Brief COPE. Int. J. Behav. Med. 4 (1): 92-100.

    Google Scholar 

  • Carver, C. S., Scheier, M. F., and Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. J. Pers. Soc. Psychol. 56 (2): 267-283.

    Google Scholar 

  • Case, R. B., Moss, A. J., Case, N., McDermott, M., and Eberly, S. (1992). Living alone after myocardial infarction. JAMA. 267: 515-519.

    Google Scholar 

  • Con, A. H., Linden, W., Thompson, J. M., and Ignaszewski, A. (1999). The psychology of men and women recovering from coronary artery bypass surgery. J. Cardiopulmon. Rehabil. 19 (3): 152-161.

    Google Scholar 

  • Costa, P. T., Somerfield, M. R., and McCrae, R. R. (1996). Personality and coping: A reconceptualization. In Zeidner, M., and Endler, N. S. (Eds.), Handbook of Coping: Theory, Research, Applications, Wiley, New Jersey, pp. 410-433.

    Google Scholar 

  • Dusseldorp, E., van Elderen, T., Maes, S., Meulman, J., and Kraaij, V. (1999). A meta-analysis of psychoeduational programs for coronary heart disease patients. Health Psychol. 18 (5): 506-519.

    Google Scholar 

  • Elizur, Y., and Hirsh, E. (1999). Psychosocial adjustment and mental health two months after coronary artery bypass surgery: A multisystemic analysis of patients' resources. J. Behav. Med. 22 (2): 157-177.

    Google Scholar 

  • Espnes, G. A. (1996). The type 2 construct and personality traits: Aggression, hostility, anxiety and depression. Pers. Indiv. Diff. 20 (5): 641-648.

    Google Scholar 

  • Frasure-Smith, N., Lesperance, F., and Talajic, M. (1993). Depression following myocardial infarction: Impact on 6-month survival. JAMA 270: 1819-1825.

    Google Scholar 

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

    Google Scholar 

  • Glassman, A. H., and Shapiro, P. A. (1998). Depression and the course of coronary artery disease. Am. J. Psychiatry 155 (1): 4-11.

    Google Scholar 

  • Hart, K. E. (1999). Cynical hostility and deficiencies in functional support: The moderating role of gender in psychosocial vulnerability to disease. Pers. Indiv. Diff. 27 (1): 69-83.

    Google Scholar 

  • Hellman, E. A. (1997). Use of the stages of change in exercise adherence model among older adults with a cardiac diagnosis. J. Cardiopulmon. Rehabil. 17 (3): 145-155.

    Google Scholar 

  • Hemingway, H., and Marmot, M. (1999). Evidence based cardiology: Psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ 318 (7196): 1460-1467.

    Google Scholar 

  • Hewitt, P. L., and Flett, G. L. (1996). Personality traits and the coping process. In Zeidner, M., and Endler, N. S. (Eds.), Handbook of Coping: Theory, Research, Applications, Wiley, New Jersey, pp. 410-433.

    Google Scholar 

  • Hillers, T. K., Guyatt, G. H., Oldridge, N., Crowe, J., Willan, A., Griffith, L., and Feeny, D. (1994). Quality of life after myocardial infarction. J. Clin. Epidemiol. 47: 1287-1296.

    Google Scholar 

  • Holahan, C. J., Moos, R. H., Holahan, C. K., and Brennan, P. L. (1997). Social context, coping strategies, and depressive symptoms: An expanded model with cardiac patients. J. Pers. Soc. Psychol. 72 (4): 918-928.

    Google Scholar 

  • Hoyle, R. H. (1995). Structural Equation Modeling, Sage, CA.

    Google Scholar 

  • Januzzi, J. L., Jr, Stern, T. A., Pasternak, R. C., and DeSanctis, R. W. (2000). The influence of anxiety and depression on outcomes of patients with coronary artery disease. Arch. Int. Med. 160 (13): 1913-1921.

    Google Scholar 

  • Jenkins, C. D., Stanton, B. A., and Jono, R. T. (1994). Quantifying and predicting recovery after heart surgery. Psychosom. Med. 56 (3): 203-212.

    Google Scholar 

  • Ladwig, K. H., Breithardt, G., Budde, T., and Borggrefe, M. (1994). Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 343: 20-23.

    Google Scholar 

  • Linden, W., Stossel, C., and Maurice, J. (1996). Psychosocial interventions for patients with coronary artery disease: A meta-analysis. Arch. Int. Med. 156 (7): 745-752.

    Google Scholar 

  • Maes, S., and Bruggemans, E. (1990). Approach-avoidance and illness behaviour in coronary heart patients. In Schmidt, L. R., Schwenkmezger, P., Weinman, J., and Maes, S. (Eds.), Health Psychology: Theoretical and Applied Aspects, Harwood, London, pp. 297-308.

  • Matthews, K. A. (1988). Coronary heart disease and Type A behaviors: Update and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psychol. Bull. 104: 373-380.

    Google Scholar 

  • Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., and Hallet, A. J. (1996). A meta-analytic review of research on hostility and physical health. Psychol. Bull. 119 (2): 322-348.

    Google Scholar 

  • Ornish, D., Scherwitz, L. W., Billings, J. H., Gould, K. L., Merritt, T. A., Sparler, S., Armstrong, W. T., Ports, T. A., Kirkeeide, R. L., Hogeboom, C., and Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA 280 (23): 2001-2007.

    Google Scholar 

  • Penninx, B. W., van Tilburg, T., Boeke, A. J., Deeg, D. J., Kriegsman, D. M., and van Eijk, J. T. (1998). Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases? Health Psychol. 17 (6): 551-558.

    Google Scholar 

  • Pierce, G. R., Sarason, I. G., and Sarason, B. R. (1996). Coping and social support. In Zeidner, M., and Endler, N. S. (Eds.), Handbook of Coping: Theory, Research, Applications, NJ, Wiley, pp. 434-451.

    Google Scholar 

  • Roitman, J. L., LaFontaine, T., and Drimmer, A. M. (1998). A new model for risk stratification and delivery of cardiovascular rehabilitation services in the long-term clinical management of patients with coronary artery disease. J. Cardiopulmon. Rehabil. 18 (2): 113-123.

    Google Scholar 

  • Roy, M. P., Steptoe, A., and Kirschbaum, C. (1998). Life events and social support as moderators of individual differences in cardiovascular and cortisol reactivity. J. Pers. Soc. Psychol. 75 (5): 1273-1281.

    Google Scholar 

  • Rozanski, A., Blumenthal, J. A., and Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99 (16): 2192-2217.

    Google Scholar 

  • Rugulies, R. (2002). Depression as a predictor for coronary heart disease: A review and meta-analysis. Am. J. Prev. Med. 23 (1): 51-61.

    Google Scholar 

  • Scheier, M. F., and Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychol., 4 (3): 219-247.

    Google Scholar 

  • Scheier, M. F., Matthews, K. A., Owens, J. F., Magovern, G. J., Sr., Lefebvre, R. C., Abbott, R. A., and Carver, C. S. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. J. Pers. Soc. Psychol. 57 (6): 1024-1040.

    Google Scholar 

  • Scheier, M. F., Matthews, K. A., Owens, J. F., Schulz, R., Bridges, M. W., Magovern, G. J., and Carver, C. S. (1999). Optimism and rehospitalization after coronary artery bypass graft surgery. Arch. Int. Med. 159 (8): 829-835.

    Google Scholar 

  • Smith, T. W. (1992). Hostility and health: Current status of a psychosomatic hypothesis. Health Psychol. 11 (3): 139-150.

    Google Scholar 

  • Smith, T. W., and Frohm, K. D. (1985). What's so unhealthy about hostility? Construct validity and psychosocial correlates of the Cook and Medley Ho scale. Health Psychol. 4 (6): 503-520.

    Google Scholar 

  • Sul, J., and Fletcher, B. (1985). The relative efficacy of avoidant and non-avoidant coping strategies: A meta-analysis. Health Psychol. 4: 249-288.

    Google Scholar 

  • Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? J. Health Soc. Behav. Spec No(4): 53-79.

    Google Scholar 

  • Thorsteinsson, E. B., James, J. E., and Gregg, M. E. (1998). Effects of video-relayed social support on hemodynamic reactivity and salivary cortisol during laboratory-based behavioral challenge. Health Psychol. 17 (5): 436-444.

    Google Scholar 

  • Williams, R. B., Barefoot, J. C., and Califf, R. M. (1992). Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. JAMA 267: 520-524.

    Google Scholar 

  • Ziegelstein, R. C. (2001). Depression in patients recovering from a myocardial infarction. JAMA 286 (13): 1621-1627.

    Google Scholar 

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Correspondence to Biing-Jiun Shen.

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Shen, BJ., McCreary, C.P. & Myers, H.F. Independent and Mediated Contributions of Personality, Coping, Social Support, and Depressive Symptoms to Physical Functioning Outcome Among Patients in Cardiac Rehabilitation. J Behav Med 27, 39–62 (2004). https://doi.org/10.1023/B:JOBM.0000013643.36767.22

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  • DOI: https://doi.org/10.1023/B:JOBM.0000013643.36767.22

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