Key result
Higher personal control negatively predicted anxiety (β=-0.211) and depression (β=-0.245), while illness identity and perceived consequences positively predicted distress (all p<0.001).
Why the study?
Psychological distress significantly impacts clinical outcomes in cardiac populations, yet the structural pathways linking cognitive illness representations to anxiety and depressive symptoms remain under-explored.
Cross-Sectional (n=264)
No
In elderly Iranian cardiac patients, over half experienced anxiety and depressive symptoms, with illness identity and perceived consequences acting as cognitive drivers of distress while perceived personal control served as a protective buffer.
Hypothesis-generating for distress screening in elderly cardiac patients; leaves open causal effects and intervention benefits in prospective trials.
Background Psychological distress significantly impacts clinical outcomes in cardiac populations, yet the structural pathways from cognitive illness representations to psychological outcomes remain under-explored. Guided by Leventhal’s Common-Sense Model of Self-Regulation, this study examined the structural pathways linking illness perceptions to anxiety and depressive symptoms in patients with heart disease. Methods This cross-sectional study included 264 elderly cardiac patients (mean age: 69.83 ± 7.80 years) in Iran. Data were collected using the Brief Illness Perception Questionnaire (Brief-IPQ) and the Hospital Anxiety and Depression Scale (HADS). Hypothesized pathways were examined using structural equation modeling (SEM). Results High prevalence rates of depressive (58.7%) and anxiety (54.5%) symptoms were observed. The structural model demonstrated excellent goodness-of-fit (χ²/df = 1.92, CFI = 0.958, TLI = 0.951, RMSEA = 0.058, SRMR = 0.045). Illness identity positively predicted both anxiety (β = 0.183, p < .001) and depression (β = 0.204, p < .001). Perceived consequences selectively predicted depression (β = 0.238, p < .001). Conversely, personal control functioned as a protective negative predictor for both anxiety (β = -0.211, p < .001) and depression (β = -0.245, p < .001). A significant positive correlation existed between latent anxiety and depression (β = 0.298, p < .001). Conclusions Illness representations function as distinct cognitive drivers of emotional distress. While symptom identity and perceived consequences amplify vulnerability, personal control acts as a critical protective buffer. Integrating cognitive reframing and control-enhancing strategies into cardiac patient care pathways may effectively mitigate psychological comorbidity.
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Lotfi et al. (2026) conducted a cross-sectional in Heart disease (coronary artery disease/ACS, heart failure, arrhythmia, valvular heart disease, cardiomyopathy) (n=264). Illness perceptions (Brief Illness Perception Questionnaire: personal control, consequences, identity) was evaluated on Depressive and anxiety symptoms (Hospital Anxiety and Depression Scale subscale score >=8 and structural equation modeling latent constructs) (β -0.245 (personal control -> depression); β -0.211 (personal control -> anxiety); β 0.238 (consequences -> depression); β 0.204 (identity -> depression); β 0.183 (identity -> anxiety), p=<0.001). Higher personal control negatively predicted anxiety (β=-0.211) and depression (β=-0.245), while illness identity and perceived consequences positively predicted distress (all p<0.001).
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