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Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure
Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet / Sophiahemmet University.ORCID iD: 0000-0002-1139-9489
Academy of Health, Care and Social Welfare, Mälardalen University.
The Swedish Red Cross University College, Department of Nursing and Care. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.ORCID iD: 0000-0003-1445-900X
Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
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2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, 704-713 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.

Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.

Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.

Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.

Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

Place, publisher, year, edition, pages
2016. Vol. 30, no 4, 704-713 p.
Keyword [en]
anxiety; avoidant coping; chronic heart failure; depression; illness perception; path analysis
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:rkh:diva-1897DOI: 10.1111/scs.12297PubMedID: 26766405OAI: oai:DiVA.org:rkh-1897DiVA: diva2:850877
Note

As manuscript in dissertation

Available from: 2015-09-02 Created: 2015-09-02 Last updated: 2017-04-28Bibliographically approved
In thesis
1. Coping and emotional well-being in patients with chronic heart failure
Open this publication in new window or tab >>Coping and emotional well-being in patients with chronic heart failure
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.

Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.

Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.

Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.

Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. 82 p.
Keyword
Heart failure; Coping; Illness perception; Emotional well-being; Quality of life; Intervention; Randomized controlled trial
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-1899 (URN)978-91-7676-001-7 (ISBN)
Public defence
2015-09-11, Sal Henry Dunant, Teknikringen 1, Stockholm, 09:00 (Swedish)
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Supervisors
Available from: 2015-09-07 Created: 2015-09-03 Last updated: 2015-09-07Bibliographically approved

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