Predictors of outcome in cardiac disease: The role of personality and illness cognitions

Abstract

Background: Coronary heart disease can have a long lasting impact on affected individuals in terms of both physical and psychological adjustment and quality of life. It is, therefore, important to investigate determinants of outcome in these patients. The thesis has four main aims; (i) to investigate predictors of outcome (adherence, quality of life, functional impairment, psychological distress and benefit finding) post-myocardial infarction (MI); (ii) to determine the prevalence and stability of Type D personality in the UK; (iii) to determine if personality predicts outcome after controlling for mood, demographic and clinical factors, and (iv) to investigate potential mechanisms which may explain the link between personality and poor prognosis in cardiac patients. Method: Five studies were conducted. In Studies 1-3, participants completed measures of Type D personality, health-related behaviour, social support and neuroticism. In Study 4, participants completed an experimental stressor with cardiovascular monitoring. Study 5 was a prospective study in which 131 MI patients completed measures of personality, illness cognitions and outcome at two time points, 3-5 days post-MI, then again 3 months later. Results: The prevalence of Type D personality in the UK is 39% in the healthy population, and 34% in the cardiac population. In addition, Type D is predictive of adherence, quality of life, and functional impairment in post-MI patients after controlling for mood, demographics, and clinical factors. Five possible mechanisms (health-related behaviour, adherence, social support, cardiovascular reactivity, and illness perceptions) by which Type D may lead to adverse outcome in cardiac patients were identified. Mood predicted quality of life and functional impairment post-MI, illness perceptions predicted quality of life post-MI, and future thinking predicted quality of life, functional impairment and depression post-MI. Discussion: These findings have important therapeutic and theoretical implications for understanding the role of personality and illness cognitions in the short-term recovery of post-MI patients.