Sociodemographic, Disease Status, and Illness Perceptions Predictors of Global Self-ratings of Health and Quality of Life Among those with Coronary Heart Disease – One Year Follow-up Study

Abstract

This one-year follow-up study (n = 130 at baseline, n =2745 at follow-up, aged 45-74 years) examined the relationship of patients' perceptions of coronary heart disease (CHD) and illness-related factors with global health status and global quality of life (QOL) ratings. The independent variables were CHD history (myocardial infarction, revascularisation), CHD severity (use of nitrates, CHD risk factors and co-morbidities) and illness perceptions. In multivariate regression analysis, CHD history and severity explained 13% of variance in global health status and 8% in global QOL ratings at the baseline. Illness perceptions increased the share of explained variance by 18% and 16% respectively. In the follow-up, illness perceptions explained a significant but modest share of variance in change in health status and QOL when baseline health status and QOL and CHD severity were adjusted for more symptoms being attributed to CHD, severe perceived consequences of CHD, as well as a weak belief in the controllability of CHD were related to poor global health status and QOL ratings. In structural path models associations of CHD severity factors were mediated by illness perceptions. The association of disease severity with dependent variables was weaker after controlling for illness perceptions. Cognitive representations of CHD contribute to both global health status and QOL ratings and they also mediate the associations between CHD severity and well-being. No gender differences were found in associations of illness perceptions with health status or QOL ratings.

Are illness perceptions about coronary artery disease predictive of depression and quality of life outcomes?

“…Analyses to predict the secondary outcome of HRQOL also showed a significant role for illness beliefs, confirming the results of the small number of prior studies that investigated this association [29,82]. It is notable that positive illness beliefs were second only to younger age in predicting physical HRQOL 3 and 9 months after cardiac hospitalization and that illness cognitions were reliably predictive of change in mental HRQOL over this 6-month period, reinforcing the clinical potential of these beliefs.…”

Into the cognitive constructs related to adherence to treatment in CHD outpatients: the importance of accepting the disease limitations

“…It may be therefore useful to implement specific interventions aimed at improving behaviour specific self-efficacy with eventual positive consequences on adherence and health status. Moreover, focusing on patients' cognitive representations of illness (cognitive/emotional antecedents) could favour the disease adjustment process as a part of the rehabilitation and training intervention [20]. The working model we propose focuses not only on the emotional aspects but above all on every day life operational and practical variables based on an intervention tailored to what has come out from the ASI-HD schedule.…”

“…Illness perception which has proved to be an important determinant of adjustment, functional and emotional health in various chronic illnesses [18,19] was confirmed important also in CHD patients, controlling for socio-demographic factors as well as CHD severity and history [20]. Interestingly, in healthy subjects change in self-efficacy -defined as the individual's belief in the possibility of achieving a particular goal - [21] resulted to be a predictor of change in smoking and nutrition behaviour [22].…”

Presentation of the Psycho-Cardiological Schedule and convergence levels analyses among the psycho-cardiological screening and the psychological assessment

“…I criteri di selezione sono stati decisi in base a evidenze scientifiche derivanti dalla letteratura [7,8] e al rilievo clinico psicologico di alcune aree di percezione/gestione della malattia [1,9].…”