engleski

The contribution of illness perception to anxiety and depression in patients with cardiac dysfunction

Background and aims: Overweight and obesity predispose to numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The prevalence of depression and anxiety is high in cardiac dysfunction (10–60% depression ; 11–45% anxiety) ; with rates of depressive disorders 2 to 4 times higher in chronic heart failure patients than in the general population (1). Comorbid depression is associated with worsening of cardiac dysfunction (CD), physical and social functioning, and quality of life (2). Subclinical symptoms of depression are also associated with treatment nonadherence and risk of complications and mortality in patients with CD (3). Objectives: The purpose of this research was to investigate the determinants of anxiety and depressive symptoms in obese or overweight adults with cardiac dysfunction (CD). Materials and methods: A total of 122 patients (38 women and 84 men) were enrolled in the study, 41.6% of the subjects were overweight and 34.2% were obese. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS), the Revised Illness Perception Questionnaire (IPQ-R) assessed the five components of the illness representation – identity, consequences, timeline, control/cure, coherence and cause in Leventhal’s Self- Regulatory Model. Results: Regression analyses showed that illness perceptions accounted for a significant proportion of the variance in both depression (33%) and anxiety (25%). The contribution of illness perceptions was greater than demographic variables (age and gender) and body mass index (BMI). The regression analysis results indicated that the significant predictors of anxiety in patients with CD were the negative consequences of illness and lower level of personal understanding of the condition. The higher BMI, the negative consequences of the illness, lower level of personal understanding and personal control are found to be potential risk factors for the development of depressive symptoms in patients with CD. Conclusion: Results of this preliminary study suggest that the cognitive components of patients’ representations of illness, especially negative consequences, coherence and personal control, can serve as important predictors in the risk assessment for the development of anxiety and depressive symptoms, rather than the objective features of the disease such number of symptoms of CD. Cognitive-behavioural therapy (CBT) for depression and anxiety in CD patients might beneficially shape illness perceptions towards a more positive emotional response. In addition to addressing negative illness cognitions CBT might also attempt to encourage more positive illness cognitions such as perceived personal control and understanding over illness. References: (1) Ladwig, KH, et al. (2014). Position paper on the importance of psychosocial factors in cardiology. German Medical Science, 12, Doc09 ; (2) Rumsfeld, JS, et al. (2003). Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. Journal of the American College of Cardiology, 42(10), 1811–1817 ; (3) Sherwood, A, et al. (2007). Relationship of depression to death or hospitalization in patients with heart failure. Archives of Internal Medicine, 167(4), 367–373.

illness perception; CVD; anxiety; depression

This research is a part of the project ‘Biopsychosocial aspects of obesity’ (number: 13.04.1.3.07) supported by grant from University of Rijeka, Croatia.