Psychosocial Predictors of Cardiac Rehabilitation Outcome

The deleterious effects of anxiety and depression have been explored in various medical populations, including cardiac populations. The strongest effects exist for depression while anxiety has yielded inconsistent findings. Self-efficacy, a closely related variable, is positively associated with health. Preliminary findings suggest that self-efficacy may mediate relationships between affective states and health outcomes. These relationships are further complicated by an individual's learning history, specifically behaviors modeled by one's parents. This study hypothesized that cardiac self-efficacy would mediate relationships between both depression and cardiac anxiety and rehabilitation outcomes. Further, exposure to an avoidant parental model was hypothesized to be negatively associated with rehabilitation outcomes. Outpatient cardiac rehabilitation patients (n=115) completed baseline measures assessing depression (CESD), attentional cardiac anxiety (CAQ), cardiac self-efficacy (CSE), and learning history. These psychosocial variables were then analyzed to determine if they were significantly associated with post-rehabilitation metabolic equivalents (METs) and provide ratings of health. Results provided partial support for hypotheses. Participants with higher levels of baseline depression displayed poorer post-rehabilitation METs. Participants with higher baseline attentional cardiac anxiety exhibited poorer post-rehabilitation METs and provider ratings of health. Cardiac self-efficacy was significantly related to baseline depression, but did not function as a mediator of either affective variable. Additionally, having an avoidant maternal model was associated with higher levels of attentional cardiac anxiety and lower post-rehabilitation provider ratings of health. These findings are novel as they clarify previous inconsistent findings regarding anxiety and cardiac health and expand upon previous research on intergenerational transmission and health outcomes.