Coronary Heart Disease: Psychological Aspects

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Psychological Aspects of Coronary Heart Disease:

81 Studies Published in 2013-2016

Kenneth S. Pope, Ph.D. ABPP

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The purpose of the web page is to help clinicians, researchers, and others to keep abreast of the evolving research on psychological factors related to the causes of, treatments for, and recovery from coronary heart disease.

I gathered the following  citations for and excerpts from 81 studies of the psychological aspects of coronary heart disease development, treatment, and recovery published in 2013, 2014, 2015, & 2016:


Alhurani, A. S., et al. (2015). "The association of co-morbid symptoms of depression and anxiety with all-cause mortality and cardiac rehospitalization in patients with heart failure." Psychosomatics: Journal of Consultation and Liaison Psychiatry 56(4): 371-380.

            "co-morbid symptoms of depression and anxiety (vs no symptoms or symptoms of anxiety or depression alone) independently predicted all-cause mortality…. To improve mortality outcomesinpatients with HF, attention must be paid by health care providers to the assessment and management of co-morbid symptoms of depression and anxiety."


Alosco, M. L., et al. (2014). "Cognitive performance in older adults with stable heart failure: Longitudinal evidence for stability and improvement." Aging, Neuropsychology, and Cognition 21(2): 239-256.

             "Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains..."


Alosco, M. L., et al. (2014). "Executive dysfunction is independently associated with reduced functional independence in heart failure." Journal of Clinical Nursing 23(5-6): 829-836.

             "Hierarchical regressions revealed that reduced executive function was independently associated with worse instrumental activity of daily living performance with a specific association for decreased ability to manage medications. Partial correlations showed that executive dysfunction was associated with current cigarette use.... Our findings suggest that executive dysfunction is associated with poorer functional independence and contributes to unhealthy behaviours in heart failure."


Alosco, M. L., et al. (2014). "Reduced cerebral perfusion predicts greater depressive symptoms and cognitive dysfunction at a 1-year follow-up in patients with heart failure." International Journal of Geriatric Psychiatry 29(4): 428-436.

             "Cerebral perfusion declined over time and was associated with poorer cognitive function and greater depressive symptoms at a 1-year follow-up in HF."


Bekkouche, N. S., et al. (2013). "Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease." Psychosom Med 75(4): 413-421.

            "In patients with ischemia, cognitive-emotional and cognitive-interpretational factors are important predictors of exercise angina."


Berecki-Gisolf, J., et al. (2013). "A history of comorbid depression and anxiety predicts new onset of heart disease." Journal of Behavioral Medicine 36(4): 347-353.

           "A history of comorbid depression and anxiety is an important predictor of new onset of heart disease in mid-aged women. Due to the possible detrimental consequences of heart disease, psychological factors as well as established predictors should be considered when assessing a person's risk for heart disease."


Bernard, C., et al. (2015). "Cerebral changes and cognitive impairment after an ischemic heart disease: A multimodal mri study." Brain Imaging and Behavior.

           "Executive dysfunction in ACS patients is associated to functional but no structural characteristics, particularly to an increased functional connectivity in cognitive networks in transient impaired patients."


Bidwell, J. T., et al. (2015). "Determinants of heart failure self-care maintenance and management in patients and caregivers: A dyadic analysis." Research in Nursing & Health.

            "Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes."


Bittman, B., et al. (2013). "Recreational Music-Making alters gene expression pathways in patients with coronary heart disease." Med Sci Monit 19: 139-147.

            "During relaxation, two pathways showed a significant change in expression in the control group, while 12 pathways governing immune function and gene expression were modulated among RMM participants. Only 13% (2/16) of pathways showed differential expression during stress and relaxation.... Relaxation through active engagement in Recreational Music Making may be more effective than quiet reading at altering gene expression and thus more clinically useful for stress amelioration."


Bluvstein, I., et al. (2013). "Posttraumatic growth, posttraumatic stress symptoms and mental health among coronary heart disease survivors." J Clin Psychol Med Settings 20(2): 164-172.

            "PTG moderated the association between PTSS and most mental health outcomes.... Posttraumatic growth may attenuate the negative effect of posttraumatic stress symptoms on mental health."


Bunevicius, A., et al. (2013). "Decreased Physical Effort, Fatigue, and Mental Distress in Patients with Coronary Artery Disease: Importance of Personality-Related Differences." Int J Behav Med.

            "Type D personality traits independently predicted poor functional status and worse patient-centered outcomes independently from LVEF [left ventricular ejection fraction] and depression. Further studies exploring personality-related differences in cardiovascular outcomes are needed."


Brouwers, C., et al. (2014). "Depressive symptoms in outpatients with heart failure: Importance of inflammatory biomarkers, disease severity and personality." Psychology & Health 29(5): 564-582.

             "Personality factors, but not inflammation, were independent concomitants of depressive symptoms in patients with HF."


Bunevicius, A., et al. (2013). "Screening for anxiety disorders in patients with coronary artery disease." Health Qual Life Outcomes 11: 37.

            "Anxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders."


Buneviciute, J., et al. (2013). "Mood symptoms and personality dimensions as determinants of health-related quality of life in patients with coronary artery disease." J Health Psychol 18(11): 1493-1504.

            "A linear regression analysis showed that symptoms of depression and anxiety as well as personality trait of emotional stability have independent significant effect on the health-related quality of life in patients with coronary artery disease. Psychological interventions in coronary artery disease patients should not only be limited to the treatment of symptoms of depression and anxiety but should also be extended to the management of personality traits."


Celano, Mastromauro, et al. (2012). "Association of baseline anxiety with depression persistence at 6 months in patients with acute cardiac illness." Psychosom Med 74(1): 93-99.

            "Among a cohort of depressed cardiac patients, higher baseline anxiety score was linked with lesser improvement in depressive symptoms and increased likelihood of depression persistence at 6 months, independent of multiple relevant covariates." 


Carroll, J. E., et al. (2013). "Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study." PNAS Proceedings of the National Academy of Sciences of the United States of America 110(42): 17149-17153.

           "Childhood abuse increases adult risk for morbidity and mortality.... [W]e related reports of childhood abuse to a comprehensive 18-biomarker measure of multisystem risk and also examined whether presence of a loving parental figure buffers against the impact of childhood abuse on adult risk.... A significant interaction of abuse and warmth...was found, such that individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multisystem risk in adulthood."


Cho, Bower, et al. (2012). "Early life stress and inflammatory mechanisms of fatigue in the Coronary Artery Risk Development in Young Adults (CARDIA) study." Brain, Behavior, and Immunity 26(6): 859-865.

            "In the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based longitudinal study conducted in 4 US cities, early life stress was retrospectively assessed in 2716 African–American and white adults using the Risky Families Questionnaire at Year 15 examination (2000–2001, ages 33–45years). Fatigue as indexed by a loss of subjective vitality using the Vitality Subscale of the 12-item Short Form Health Survey was assessed at both Years 15 and 20. While CRP [C-reactive protein] was measured at both Years 15 and 20, IL-6 was measured only at Year 20. Early life stress assessed at Year 15 was associated with adulthood fatigue at Year 20 after adjustment for sociodemographic characteristics, body-mass index, medication use, medical comorbidity, smoking, alcohol consumption, physical activity, current stress, pain, sleep disturbance as well as Year 15 fatigue (adjusted beta 0.047, P =0.007). However, neither CRP nor IL-6 was a significant mediator of this association. In summary, early life stress assessed in adulthood was associated with fatigue 5years later, but this association was not mediated by low-grade systemic inflammation." 


Chaudhury, S. and K. Srivastava (2013). "Relation of Depression, Anxiety, and Quality of Life with Outcome after Percutaneous Transluminal Coronary Angioplasty." ScientificWorldJournal 2013: 465979.

            "Successful PTCA resulted in significant reduction in anxiety, depression, and physical limitation and improvement in disease perception and health status."


Chauvet-Gelinier, J. C., et al. (2013). "Review on depression and coronary heart disease." Arch Cardiovasc Dis 106(2): 103-110.

            "There is a bidirectional relationship between CHD and mood disorders, with a strong co-occurrence of the two diseases accompanied by a reciprocal worsening of the prognosis for the two conditions. Various epidemiological studies have shown that depression is a psychic risk factor for CHD and that CHD is present in almost 30% of patients with affective disorders."


Compare, A., et al. (2013). "Social support, depression, and heart disease: A ten year literature review." Frontiers in Psychology 4.

           "Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease.... The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations.... Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients."


Compare, A., et al. (2013). "Stress-induced cardiomyopathy and psychological wellbeing 1 year after an acute event." Journal of Clinical Psychology in Medical Settings.

           "Stress cardiomyopathy (SCM) typically presents similar symptoms to acute myocardial infarction (AMI). However, these symptoms differ when it comes to a transient and completely reversible myocardial dysfunction, which is frequently precipitated by acute stressful events, occurring in the absence of plaque rupture and coronary thrombosis.... Thirty-seven SCM patients were compared with 37 matched AMI patients. All selected patients were assessed for HRQL and psychological distress at baseline and 1-year after the acute event. After controlling for covariates, scores on the Psychological General Well Being Index indicated that depressed mood had increased in both groups, but the increase for SCM patients was greater than for AMI patients. The AMI group displayed greater decreases than the SCM in physical quality of life and in total cardiac-related health quality of life. The percentage of patients with psychological distress increased significantly more in the SCM group than in the AMI group, and it made no difference whether the triggering event was emotional or physical. Our results suggest that, despite the more favorable medical prognosis of SCM patients, their cardiac condition being transient and resolving completely in few weeks, the psychological impact associated with their condition is more negative 1 year later than in the case of AMI patients whose medical prognosis is less favorable, and this difference is independent of type of trigger event."


Cornett, L. and J. Simms (2014). "At the 'heart' of the matter: An exploration of the psychological impact of living with congenital heart disease in adulthood." Journal of Health Psychology 19(3): 393-406.

           "Participants described living with congenital heart disease as a constant and limiting presence, which impacts upon the relationship with self and others. Psychological and emotional reactions ranged from depression, shame, trauma, lack of control and an ongoing struggle with issues of uncertainty and life expectancy. Various coping strategies were identified such as denial and overcompensation. Participants reported that they were not psychologically supported by health professionals.


Cramer, H., et al. (2015). "Mind–body medicine in the secondary prevention of coronary heart disease: A systematic review and meta-analysis." Deutsches Ärzteblatt International 112(45): 759-767.

             "In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs."


Damen, N. L., et al. (2013). "Reduced positive affect (anhedonia) is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: results from the RESEARCH registry." Eur J Prev Cardiol 20(1): 127-134.

            "Anhedonia was independently associated with a 1.5-fold increased risk for all-cause mortality in patients who survived the first 6 months post-PCI. Enhancing positive emotions, in addition to reducing negative emotions, may constitute an important target for future psychological intervention trials in CAD patients."


Emeny, R. T., et al. (2013). "Job strain-associated inflammatory burden and long-term risk of coronary events: findings from the MONICA/KORA Augsburg case-cohort study." Psychosom Med 75(3): 317-325.            

           "Job strain increased CHD risk in healthy workers; the associated inflammatory burden may contribute to stress-related coronary pathogenesis."  


Faller, H., et al. (2015). "Depressive symptoms in heart failure: Independent prognostic factor or marker of functional status?" Journal of Psychosomatic Research 78(6): 569-572.

           "Depressive symptoms predicted mortality risk…even after adjustment for heart failure severity and co-morbidities…. Our results suggest that the association of depressive symptoms with functional status may at least partly explain the prognostic potential of depressive symptoms."


Fan, Z., et al. (2013). "Schizophrenia and the risk of cardiovascular diseases: A meta-analysis of thirteen cohort studies." Journal of Psychiatric Research 47(11): 1549-1556.

           "The meta-analysis found that the pooled RRs for schizophrenia compared with the reference group were 1.53...for the incidence of CVD, 1.20...for coronary heart disease (CHD), 1.71...for stroke, and 1.81...for congestive heart failure (CHF). Sensitivity analysis after the exclusion of a single cohort or using the unadjusted RRs yielded similar results to the primary overall estimations. No evidence of publication bias was observed.... Schizophrenia is associated with increased incidence of CVD, stroke and CHF, and might also increase the risk of CHD. Greater attention should be paid to schizophrenia patients to prevent the occurrence of CVD and to decrease the risk of cardiac morbidity."


Ferrie, J. E., et al. (2013). "Job insecurity and incident coronary heart disease: the Whitehall II prospective cohort study." Atherosclerosis 227(1): 178-181.

            "Cox proportional hazard models adjusted for socio-demographic characteristics showed job insecurity to be associated with a 1.42-fold...risk of incident coronary heart disease compared with secure employment. Adjustment for physiological and behavioral cardiovascular risk factors had little effect on this estimate.... This study suggests that job insecurity may adversely affect coronary health."


Fiabane, E., et al. (2013). "Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?" Int Arch Occup Environ Health 86(5): 561-569.

            "The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors."


Galick, A., et al. (2015). "Can anyone hear me? Does anyone see me? A qualitative meta-analysis of women's experiences of heart disease." Qualitative Health Research 25(8): 1123-1138.

             "Women's descriptions of their experiences suggest three kinds of health care strategies that have the potential to increase women's engagement with heart disease treatment and rehabilitation: (a) support give and take in relational connections, (b) identify and acknowledge unique health-promoting behavior, and (c) focus on empowerment."


Garfield, L. D., et al. (2014). "Association of anxiety disorders and depression with incident heart failure." Psychosomatic Medicine 76(2): 128-136.

             "Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran's Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications."


Glozier, N., et al. (2013). "Psychosocial risk factors for coronary heart disease." Med J Aust 199(3): 179-180.

            "Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD.  Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive.... Social isolation after myocardial infarction (MI) is associated with an adverse prognosis.... Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low."


Grady, K. L., et al. (2014). "Does self-management counseling in patients with heart failure improve quality of life? Findings from the Heart Failure Adherence and Retention Trial (HART)." Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation 23(1): 31-38.

             "[I]n our cohort of patients, the self-management intervention had no benefit over enhanced education in improving domains of HRQOL and HRQOL for specified HF subgroups."


Habota, T., et al. (2015). "Prospective memory impairment in chronic heart failure." Journal of the International Neuropsychological Society 21(3): 183-192.

               "The CHF group exhibited significant PM impairment, with difficulties generalizing across different types of PM tasks (event, time, regular, irregular). The CHF group also had moderate deficits on several of the background cognitive measures. Given the level of impairment remained consistent even on tasks that imposed minimal demands on memory for task content, CHF-related difficulties most likely reflects problems with the prospective component. However, exploratory analyses suggest that difficulties with retrospective memory and global cognition (but not executive control), also contribute to the PM difficulties seen in this group…. Patient engagement in CHF self-care behaviors is often poor."


Hawkins, M. A. W., et al. (2015). "Cognitive function in heart failure is associated with nonsomatic symptoms of depression but not somatic symptoms." Journal of Cardiovascular Nursing 30(5): E9-E17.

                "Greater overall depressive symptom severity was associated with poorer performance on multiple cognitive domains, an effect driven primarily by the nonsomatic symptoms of depression…. These findings suggest that screening explicitly for nonsomatic depressive symptoms may be warranted and that the mechanisms underlying the depression-cognitive function relationship in HF are not solely related to sleep or appetite disturbance. Thus, interventions that target patients' somatic symptoms only (eg, poor appetite or fatigue) may not yield maximum cognitive benefit compared with a comprehensive treatment that targets depressed mood, anhedonia, and other nonsomatic symptoms."


Hwang, B., et al. (2015). "Changes in depressive symptoms and mortality in patients with heart failure: Effects of cognitive-affective and somatic symptoms." Psychosomatic Medicine 77(7): 798-807.

            "Worsening somatic depressive symptoms, not cognitive-affective symptoms, are independently associated with increased mortality of HF patients. The findings suggest that routine and ongoing assessment of somatic depressive symptoms in HF patients may help clinicians identify patients at increased risk for adverse outcomes."


Jiang, W., et al. (2013). "Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease." J Am Coll Cardiol 61(7): 714-722.

            "Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia."


Jokela, M., et al. (2013). "Personality traits as risk factors for stroke and coronary heart disease mortality: Pooled analysis of three cohort studies." Journal of Behavioral Medicine.

           "We examined whether personality traits are differently associated with coronary heart disease and stroke mortality. Participants were pooled from three prospective cohort studies (Health and Retirement Study, Wisconsin Longitudinal Study graduate and sibling samples; n = 24,543 men and women, mean age 61.4 years, mortality follow-up between 3 and 15 years)....Higher extraversion was associated with an increased risk of stroke (hazard ratio per each standard deviation increase in personality trait...but not with coronary heart disease mortality.... High neuroticism, in turn, was more strongly related to the risk of coronary heart disease...than stroke deaths.... High conscientiousness was associated with lower mortality risk from both coronary heart disease...and stroke.... Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints."


Kähkönen, O., et al. (2015). "Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention." Journal of Advanced Nursing 71(10): 2364-2373.

            Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention.


Kim, E. S., et al. (2013). "Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up." J Behav Med 36(2): 124-133.

            "Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period.... The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease."


Kim, J.-M., et al. (2015). "BDNF methylation and depressive disorder in acute coronary syndrome: The K-DEPACS and EsDEPACS studies." Psychoneuroendocrinology 62: 159-165.

            "ACS patients with higher BDNF methylation were susceptible to early depressive disorder, and to its persistence one year later. Adequate antidepressants treatment may effective particularly in those with higher BDNF methylation and then can overcome epigenetic vulnerability for depression persistence in ACS patients."


Kivimaki, M., et al. (2013). "Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data." CMAJ 185(9): 763-769.

            "The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain."


Lazzarino, A. I., et al. (2013). "Low socioeconomic status and psychological distress as synergistic predictors of mortality from stroke and coronary heart disease." Psychosom Med 75(3): 311-316.

            "People in low socioeconomic circumstances are more vulnerable to the adverse effect of psychological distress. This pattern should be taken into account when evaluating the association between psychosocial variables and health outcomes."


Lockwood, N. L. and S. M. Yoshimura (2014). "The heart of the matter: The effects of humor on well-being during recovery from cardiovascular disease." Health Communication 29(4): 410-420.

             "[G]eneral humorousness associated with social and psychological well-being.... Antidote humor increased social and psychological health perceptions, whereas conversation regulation humor and distancing humor were negatively related to perceived social and psychological health. Relationship satisfaction mediated most effects"


Lossnitzer, N., et al. (2015). "A patient-centered perspective of treating depressive symptoms in chronic heart failure: What do patients prefer?" Patient Education and Counseling 98(6): 783-787.

            "64.7% of the sample reported that they could envision adhering to supportive talks at longer intervals, whereas only 34.1% would accept an antidepressant. After three months, 24.7% of the patients had actually participated in a treatment. Generalized anxiety severity (GAD-7) was very closely associated with treatment preferences and treatment utilization: The higher the generalized anxiety severity, the more likely was the patients' disposition to begin an antidepressant and/or psychotherapy."


Ma, Y., et al. (2013). "Relations of depressive symptoms and antidepressant use to body mass index and selected biomarkers for diabetes and cardiovascular disease." American Journal of Public Health 103(8): e34-e43.

           "Among 1950 women, elevated depressive symptoms were significantly associated with increased insulin levels and measures of insulin resistance. Analyses of baseline data from 2242 women showed that both elevated depressive symptoms and antidepressant use were associated with higher C-reactive protein levels.... Monitoring body habitus and other biomarkers among women with elevated depression symptoms or taking antidepressant medication may be prudent to prevent diabetes and cardiovascular disease."


Magyar-Russell, G., et al. (2013). "In Search of Serenity: Religious Struggle Among Patients Hospitalized for Suspected Acute Coronary Syndrome." J Relig Health.

            "Fifty-eight percent of the sample reported some degree of religious struggle. Questioning the power of God was the most frequently endorsed struggle. Those struggling religiously reported significantly more symptoms of anxiety, depression, and sleep disturbance. Non-White participants endorsed greater use of positive religious coping strategies and religious struggle.... Results suggest that patients hospitalized for suspected ACS experiencing even low levels of religious struggle might benefit from referral to a hospital chaplain or appropriately trained mental health professional for more detailed religious and spiritual assessment."


Marke, V. and P. Bennett (2013). "Predicting post-traumatic stress disorder following first onset acute coronary syndrome: Testing a theoretical model." Br J Clin Psychol 52(1): 70-81.

            "At 1-month follow-up, predictors of PTSD symptoms were as follows: peri-traumatic distress, concern over symptoms, illness comprehension, and lack of social support. At 6-month follow-up, predictors were: peri-traumatic distress, lack of social support, use of problem-focused coping, and continued symptoms.... The Joseph et al. model was generally supported. The data allow some degree of prediction of high risk individuals and suggest some possible interventions."


Matthews, K. A. (2013). "Matters of the heart: Advancing psychological perspectives on cardiovascular diseases." Perspectives on Psychological Science 8(6): 676-678.

         "Cardiovascular diseases (CVD) are the major cause of death in men and women in the United States. Type A behavior research was a starting point for psychological science's understanding of the development of CVD. Health psychology science has broadened its scope to consider other psychological constructs as potential risk factors, multilevel models and a life span approach, and new mechanistic pathways that could apply to a number of disease outcomes other than CVD.... Another trend is the multilevel approach to understanding the development of CVD, taking into account not only individual behavior and their pathophysiological sequalae but also environmental, genetic, and cognitive/brain processing inputs. It is widely recognized that individual behavior is embedded in the larger context of the community, work, and home environments and that these environmental factors vary by socioeconomic status (SES), race/ethnicity, and gender. Furthermore, genetic factors influence behavioral responses to these environments. Neuroscientists have identified brain pathways that have downstream effects on peripheral physiology that ultimately could affect CVD risk.... Accumulating evidence suggests that difficult circumstances in childhood and adolescence (e.g., abuse, harsh parenting, psychiatric illness of parent) are related to CVD risk factors, inflammation, and CHD morbidity (Danese et al., 2009; Felitti et al., 1998). Low SES in childhood and adolescence is related to adult risk for CVD morbidity and mortality, in some cases even after taking into account adult SES (Galobardes, Smith, & Lynch, 2006)."


Middel, B., et al. (2013). "Decline in Health-Related Quality of Life 6 Months After Coronary Artery Bypass Graft Surgery: The Influence of Anxiety, Depression, and Personality Traits." J Cardiovasc Nurs.

            "The results of the current study show that Type D personality comprised a vulnerability factor for poor patient-reported outcomes (ie, HRQoL and distress), and despite significant and clinically relevant benefits also for Type D patients after CABG, their well-being remained poorer than that of non-Type D participants at 6 months. Increased levels of anxiety largely mediated the influence of Type D personality on no change-deterioration trajectories in both physical and mental HRQoL, whereas increased symptoms of depression explained deterioration in physical and mental HRQoL without the influence of Type D personality."


Mills, P. J., et al. (2015). "Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients." Journal of Behavioral Medicine 38(3): 407-415.

            "Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure."


Nyklicek, I., et al. (2014). "A brief mindfulness based intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (PCI) patients: The mindfulheart randomized controlled trial." Journal of Behavioral Medicine 37(1): 135-144.

           "The brief group mindfulness intervention seems beneficial for cardiac PCI patients regarding general psychosocial quality of life, although for specific psychological symptoms, this intervention can be recommended only for nonelderly patients."


O'Doherty, V., et al. (2015). "A controlled evaluation of mindfulness-based cognitive therapy for patients with coronary heart disease and depression." Mindfulness: 6(3): 405-416.

           "This study evaluated the effectiveness of an eight-session mindfulness-based cognitive therapy (MBCT) group intervention programme for treating depression in coronary heart disease (CHD) patients. Thirty-two depressed CHD patients were assigned to an MBCT treatment group, and a demographically and clinically similar group of 30 cases were assigned to a waiting list control group.... The MBCT group showed significantly greater improvement than the control group on all measures.... Increases in mindfulness on the MAAS correlated significantly with improvements on the HADS, BSI, POMS and PAIS. Key helpful aspects of therapy identified by MBCT participants included learning meditation, obtaining group support and developing optimism. There was a high level of satisfaction with the MBCT programme."


Ossola, P., et al. (2015). "Risk factors for incident depression in patients at first acute coronary syndrome." Psychiatry Research 228(3): 448-453.

             "At baseline risk factors for a post-ACS depressive disorder were being women (MD only), widowed (md only) and having mild anhedonic depressive symptoms few days after the ACS. Clinicians should keep in mind these variables when facing a patient at his/her first ACS, given the detrimental effect of depression on cardiac prognosis."


Panzaru, G. M. and A. Holman (2015). "Type of treatment of cardiac disorders—Quality of life and heart-focused anxiety: The mediating role of illness perceptions." Psychology, Health & Medicine 20(5): 551-559.

            "The influence of the type of treatment on the heart-focused anxiety and on the quality of life was mediated by illness perceptions. Consequently, patients who have undergone cardiac surgery have a better quality of life and lower levels of heart-focused anxiety than those relying only on medication to treat their illness.


Park, J.-H., et al. (2015). "Depression and anxiety as predictors of recurrent cardiac events 12 months after percutaneous coronary interventions." Journal of Cardiovascular Nursing 30(4): 351-359.

            "A moderate or severe level of anxiety (hazard ratio, 6.21; 95%confidence interval, 1.64-23.54) and a moderate or severe level of depression (hazard ratio, 4.32; 95% confidence interval, 1.35-13.88) were independent predictors of recurrent cardiac events….  Patients with CAD who have a high level of anxiety and depression are at increased risk for recurrent cardiac events after PCI. Screening should be focused on patients who experience anxious and depressive feelings in addition to traditional risk factors. Furthermore, psychoeducational support interventions to reduce anxiety and depression after PCI may improve health outcomes."


Parswani, M. J., et al. (2013). "Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial." Int J Yoga 6(2): 111-117.

            "Significant reduction was observed in symptoms of anxiety and depression, perceived stress, BP and BMI in patients of the MBSR group after the completion of intervention assessment. At 3-month follow-up, therapeutic gains were maintained in patients of the MBSR group. CONCLUSION: The MBSR program is effective in reducing symptoms of anxiety and depression, perceived stress, BP and BMI in patients with CHD.


Perrotti, A., et al. (2015). "Relationship between depression and health-related quality of life in patients undergoing coronary artery bypass grafting: A motiv-cabg substudy." Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation.

            "Preoperative depression has a negative impact on HRQoL improvement during postoperative follow-up after CABG. It seems important to detect depression before CABG to begin antidepressant therapy and improve patients' HRQoL."


Plourde, A., et al. (2013). "Hemodynamic, hemostatic, and endothelial reactions to acute psychological stress in depressed patients following coronary angiography." Psychophysiology 50(8): 790-798.

           "In total, 21% of the participants were depressed. Analyses revealed that depression was associated with blunted pre-ejection period stress reactivity and with increased platelet factor 4 reactivity. These data provide potential mechanistic pathways linking depression to increased CAD."


Pössel, P., Mitchell, A. M., Ronkainen, K., Kaplan, G. A., Kauhanen, J., & Valtonen, M. (2015). Do depressive symptoms predict the incidence of myocardial infarction independent of hopelessness?. Journal of health psychology, 20(1), 60-68.

              "Depression and hopelessness predicted myocardial infarction in independent regressions, but when adjusting for each other, hopelessness, but not depression, predicted myocardial infarction incidents. Thus, these results suggest that depression and hopelessness are not independent predictors of myocardial infarction."


Ravven, S., et al. (2013). "Depressive symptoms after CABG surgery: a meta-analysis." Harv Rev Psychiatry 21(2): 59-69.

           "The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression.... Systematic screening for depression in the period both before and after this procedure is crucial. Identifying depression in CABG patients is important in view of the high comorbidity of depression in those with coronary artery disease, the negative effect of depression on postoperative recovery, morbidity, and mortality, and the treatability of depression."


Reges, O., et al. (2013). "Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome." BMC Public Health 13: 956.

            "IC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed to explain the gap between Arab and Jewish patients in those behaviors, other explanatory pathways such as psychological state or cultural views should be considered as potential areas for further research."


Reid, J., et al. (2013). "Psychological interventions for patients with coronary heart disease and their partners: a systematic review." PLoS One 8(9): e73459.

            "The small number of studies included in the review had generally poor methodology, as shown by the risk of bias, and were performed over 10 years ago. As only two of the seven studies resulted in modest improvements in outcomes, no firm conclusions can be drawn as to the effectiveness of such interventions in this population."


Ronaldson, A., et al. (2015). "Optimism and recovery after acute coronary syndrome: A clinical cohort study." Psychosomatic Medicine 77(3): 311-318.

             "Optimism predicts better physical and emotional health after ACS. Measuring optimism may help identify individuals at risk. Pessimistic outlooks can be modified, potentially leading to improvesrecovery after major cardiac events."


Rostamian, S., et al. (2015). "Executive function, but not memory, associates with incident coronary heart disease and stroke." Neurology 85(9): 783-789.

            "Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke. Lower executive function, as an independent risk indicator, might better reflect brain vascular pathologies."


Roy, S. S., et al. (2015). "Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans." American Journal of Public Health 105(4): 757-763.

            "Over a mean follow-up of 7.2 years, veterans with PTSD were at increased risk for developing heart failure (hazard ratio [HR] = 1.47; 95% confidence interval [CI] = 1.13, 1.92) compared with veterans without PTSD after adjustment for age, gender, diabetes, hyperlipidemia, hypertension, body mass index, combat service, and military service period. Additional predictors for heart failure included age (HR = 1.05; 95% CI = 1.03, 1.07), diabetes (HR = 2.54; 95% CI = 2.02, 3.20), hypertension (HR = 1.87; 95% CI = 1.42, 2.46), overweight (HR = 1.72; 95% CI = 1.25, 2.36), obesity (HR = 3.43; 95% CI = 2.50, 4.70), and combat service (HR = 4.99; 95% CI = 1.29, 19.38)….  Prevention and treatment efforts for heart failure and its associated risk factors should be expanded among US veterans with PTSD."


Sanjuan, P., et al. (2014). "Effect of negative attributions on depressive symptoms of patients with coronary heart disease after controlling for physical functional impairment." British Journal of Health Psychology 19(2): 380-392.

             "These results seem to support that negative attributions about the disease are one of the causes contributing to the development of depression and not a consequence of it, and also suggest that intervention programme should be aimed not only at reducing depressive symptoms, but also at replacing stable and global attributions of negative situations with more unstable and specific explanations.


Sarrechia, I., et al. (2015). "Neurodevelopmental outcome after surgery for acyanotic congenital heart disease." Research in Developmental Disabilities 45-46: 58-68.

            "ASD-II patients showed lower scores in domains of visuospatial processing, language, attention, and social perception. VSD patients displayed subtle problems in attention and visuospatial information processing. Only few perioperative medical factors, but also socioeconomic variables were associated with cognitive outcomes. Parents of ASD-II patients reported more school problems when compared to controls…. After treatment for aCHD, subtle cognitive difficulties can present in domains of visuospatial information processing, language, attention, and social perception. These shortcomings might hamper school performances, as is suggested by lower school competence ratings. Ongoing follow-up and cognitive screening is warranted to promote developmental progress, in which both parents and clinicians share responsibility."


Sin, N. L., et al. (2016). "Direction of association between depressive symptoms and lifestyle behaviors in patients with coronary heart disease: The heart and soul study." Annals of Behavioral Medicine.

            "Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence, and sleep quality."


Spaling, M. A., et al. (2015). "Improving support for heart failure patients: A systematic review to understand patients' perspectives on self-care." Journal of Advanced Nursing 71(11): 2478-2489.

            "Findings indicate that while patients could often recall health professionals' self-care advice, they were unable to integrate this knowledge into daily life. Attempts to manage HF were based on how patients 'felt' rather than clinical indicators of worsening symptoms. Self-efficacy and learning from past management experiences facilitated favourable outcomes—these enabled patients and caregivers to adeptly apply self-care strategies into daily activities….  Addressing common but basic knowledge misconceptions regarding the domains of HF self-care is insufficient to increase effective HF self-care; this should be supplemented with strategies with patients and family members to promote self-efficacy, learning and adaptation/application of recommendations to daily life."


Stewart, T. L., et al. (2016). "Attributing heart attack and stroke to "old age": Implications for subsequent health outcomes among older adults." Journal of Health Psychology 21(1): 40-49.

            "Endorsement of 'old age' as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years."


Strodl, E. and J. Kenardy (2013). "A history of heart interventions moderates the relationship between psychological variables and the presence of chest pain in older women with self-reported coronary heart disease." British Journal of Health Psychology 18(4): 687-706.

           "This study examines the hypothesis that a past history of heart interventions will moderate the relationship between psychosocial factors (stressful life events, social support, perceived stress, having a current partner, having a past diagnosis of depression or anxiety over the past 3 years, time pressure, education level, and the mental health index) and the presence of chest pain in a sample of older women.... [F]or the women with self-reported coronary heart disease but without a past history of heart intervention, feelings of time pressure as well as the number of stressful life events experienced in the 12 months prior to 1996 were independent risk factors for the presence of chest pain, even after accounting for a range of traditional risk factors. In comparison, for the women with self-reported coronary heart disease who did report a past history of heart interventions, a diagnosis of depression in the previous 3 years was the significant independent risk factor for chest pain even after accounting for traditional risk factors....The results indicate that it is important to consider a history of heart interventions as a moderator of the associations between psychosocial variables and the frequency of chest pain in older women."


Tully, P. J. and S. M. Cosh (2013). "Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: A meta-analysis." Journal of Health Psychology 18(12): 1601-1616.

           "Lifetime generalized anxiety disorder prevalence was 25.80 per cent.... In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30..., suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis."


Tully, P. J., et al. (2013). "A review of the affects of worry and generalized anxiety disorder upon cardiovascular health and coronary heart disease." Psychology, Health & Medicine 18(6): 627-644.

           "The association between worry, GAD and CHD risk factors (e.g. blood pressure), and HRV are leading mechanisms of cardiopathogenesis that may affect cardiovascular function. Findings regarding worry and GAD in established CHD are less clear."


Tully, P. J., et al. (2014). "The real world mental health needs of heart failure patients are not reflected by the depression randomized controlled trial evidence." PLoS ONE 9(1).

"In this real-world sample comparable in size to recent RCT intervention arms, patients with depression disorders presented with complex psychiatric needs including comorbid personality disorders, alcohol/substance use and suicide risk. These findings suggest external validity of depression screening and RCTs could serve as a basis for level A guideline recommendations in cardiovascular diseases."


 Versteeg, H., et al. (2013). "Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease." Journal of Psychosomatic Research 75(6): 518-525.

            "The current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial."


Virtanen, M., et al. (2013). "Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis." BMJ 347: f4746.

            "The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity."


Vlachaki, C. and K. Maridaki Kassotaki (2013). "Coronary heart disease and emotional intelligence." Glob J Health Sci 5(6): 156-165.

            "The results showed that there is a link between the regulation of emotions and the occurrence of CHD."


Waring, M. E., et al. (2015). "Perceiving one's heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication." Patient Education and Counseling.

            "One week post-discharge, 30.3% perceived their heart condition to be cured. Characteristics associated with cure perceptions were older age…, male sex…, history of hypertension…, history of stroke…, no history of CHD…, and receipt of CABG during hospitalization…. Conversations with patients should frame ACS as a chronic disease and dispel cure perceptions."



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