Association between Behavioral Flexibility and Psychological Distress in Patients with Cardiovascular Disease

Objective: Being able to adapt to a changing environment has been associated with better mental and physical health. This adaptivity can be measured by behavioral flexibility assessment tools. However, the mental health consequences of behavioral flexibility have not been examined in patients with cardiovascular disease (CVD). The current study aims to examine if behavioral flexibility is associated with depression and anxiety in patients with CVD. Methods: A total of n = 387 patients with stable CVD were recruited as a part of the Do CHANGE study. At baseline, 3, and 6 months, data were collected. Depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder Scale-7) were assessed at all time points. Results: The mean age of the sample was 61.9 ± 10.23 years, with 274 (71%) being male. An inverse association between behavioral flexibility and depression at baseline, 3, and 6 months was observed. The associations remained significant after adjusting for relevant demographic and medical variables and baseline depression. No longitudinal association between behavioral flexibility and anxiety was found in the multivariate models. Conclusions: Behavioral flexibility is associated with depression in cardiac patients. Future studies should focus on examining the pathways of this association and offering patients with low flexibility levels additional care if needed.