Psychosocial perspectives in cardiovascular disease
Open accessAbstract
Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes.
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Clinical and subthreshold depression or anxiety increase risk of hospitalisation.
“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
From Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol (2021) · cites this paper as [4]
The Negative emotions section (p. 4) links depression and anxiety in people with known cardiovascular disease to rehospitalisation. It also distinguishes depressive disorders from clinically relevant symptoms, but does not specifically establish that subthreshold depression or anxiety increases rehospitalisation risk. (LLM, conf=0.83)
Experimental — accuracy not yet measuredClinical and subthreshold depression or anxiety comprise barriers for lifestyle changes.
“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
From Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol (2021) · cites this paper as [4]
The paper says that distress such as depression is a barrier to behaviour change and a healthy lifestyle (p. 2), and links psychosocial factors to barriers to lifestyle change (Biological and behavioural pathways, p. 7). It does not establish that subthreshold depression or anxiety specifically poses that barrier. (LLM, conf=0.84)
Experimental — accuracy not yet measuredClinical and subthreshold depression or anxiety increase risk of premature death.
“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
From Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol (2021) · cites this paper as [4]
The “Negative emotions” section (p. 4) links depression and anxiety in people with known cardiovascular disease to death and notes that clinically relevant depressive symptoms are more common than diagnosed depression. It does not establish a death-risk finding specifically for subthreshold depression or anxiety, or describe the deaths as premature. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDepression is associated with risk of non-adherence to cardiac rehabilitation and dropout.
“Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death.”
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- Authors
- Pedersen, S. S., von Känel, R., Tully, P. J., & Denollet, J.
- Affiliations
- University of Southern Denmark (DK)
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Switzerland
- Université de Bordeaux (FR)
- Tilburg University (NL)
- Corresponding author
- Pedersen, Susanne S
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06
- Volume
- 24
- Issue
- 3_suppl
- Pages
- 108-115
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W2625623957
- Cited by
- 210
- References
- 40
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 19 · 2023: 31 · 2022: 33 · 2021: 29 · 2020: 29 · 2019: 23 · 2018: 19 · 2017: 4
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- Tilburg University Research Portal (publishedVersion)
- PubMed (publishedVersion)
- RUNE (Research UNE) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Figshare (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- cardiovascular disease, psychosocial risk factors, depression, anxiety, distress, health literacy, socioeconomic factors, medication adherence, quality of life, psychosocial screening, biological mechanisms, behavioral mechanisms, patient-reported outcomes
- MeSH terms
- Adaptation, Psychological, Anxiety, Cardiovascular Diseases, Depression, Health Status, Humans, Health Knowledge, Attitudes, Practice, Mental Health, Quality of Life, Risk Factors, Socioeconomic Factors, Stress, Psychological, Health Behavior, Comorbidity, Incidence, Prevalence, Cost of Illness
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