Skip to main content

Advertisement

Log in

Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Previous research has indicated that anxiety may be associated with adverse health outcomes in heart failure patients. Little research, however, has explored whether anxiety interacts with patients’ coping strategies in their associations with physical functioning. The present study examined whether coping strategies moderated the association between anxiety and self-rated physical functioning in 273 heart failure patients. Hierarchical multiple regression analysis, adjusting for demographic and medical covariates, indicated that both anxiety (b = 1.15, β = 0.46, P < 0.001) and avoidant coping (b = 0.43, β = 0.16, P < 0.01) were significantly associated with poorer physical functioning in separate models. Results also demonstrated a significant interaction between avoidant coping and anxiety (b = 0.56, β = 0.14, P < 0.01), such that the association between anxiety and poorer physical functioning was stronger for patients who frequently used avoidant coping strategies than for those who avoided less frequently. Approach coping, however, was not directly associated with physical functioning, nor did it moderate the association between anxiety and physical functioning. The findings suggest that anxious heart failure patients who engage in avoidant coping may be at particular risk for physical dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Allman, E., Berry, D., & Nasir, L. (2009). Depression and coping in heart failure patients: A review of the literature. Journal of Cardiovascular Nursing, 24, 106–117.

    PubMed  Google Scholar 

  • American Heart Association. (2010). Heart disease and stroke statistics—2010 update: American Heart Association.

  • Barger, S. D., Marsland, A. L., Bachen, E. A., & Manuk, S. B. (2000). Repressive coping and blood measures of disease risk: Lipids and endocrine and immunological responses to a laboratory stressor. Journal of Applied Social Psychology, 30, 1619–1638.

    Article  Google Scholar 

  • Billings, D. W., Folkman, S., Acree, M., & Moskowitz, J. T. (2000). Coping and physical health during caregiving: The roles of positive and negative affect. Journal of Personality and Social Psychology, 79, 131–142.

    Article  PubMed  CAS  Google Scholar 

  • Billings, A. G., & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine, 4, 139–157.

    Article  PubMed  CAS  Google Scholar 

  • Carels, R. A., Musher-Eizenman, D., Cacciapaglia, H., Perez-Benitez, C. I., Christie, S., & O’Brien, W. (2004). Psychosocial functioning and physical symptoms in heart failure patients: A within individual approach. Journal of Psychosomatic Research, 56, 95–101.

    Article  PubMed  Google Scholar 

  • Carrico, A. W., Antoni, M. H., Duran, R. E., Ironson, G., Penedo, F., Fletcher, M. A., et al. (2006). Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Annals of Behavioral Medicine, 31, 155–164.

    Article  PubMed  Google Scholar 

  • Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4, 92–100.

    Article  PubMed  CAS  Google Scholar 

  • Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.

    Article  PubMed  CAS  Google Scholar 

  • Clarke, S. P., Frasure-Smith, N., Lesperance, F., & Bourassa, M. G. (2000). Psychosocial factors as predictors of functional status at 1 year in patients with left ventricular dysfunction. Research in Nursing and Health, 23, 290–300.

    Article  PubMed  CAS  Google Scholar 

  • Cully, J. A., Johnson, M., Moffett, M. L., Khan, M., & Deswal, A. (2009). Depression and anxiety in ambulatory patients with heart failure. Psychosomatics, 50, 592–598.

    PubMed  Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.

    Article  PubMed  CAS  Google Scholar 

  • Doering, L. V., Dracup, K., Caldwell, M. A., Moser, D. K., Erickson, V. S., Fonarow, G., et al. (2004). Is coping style linked to emotional states in heart failure patients? Journal of Cardiac Failure, 10, 344–349.

    Article  PubMed  Google Scholar 

  • Friedmann, E., Thomas, S. A., Liu, F., Morton, P. G., Chapa, D., & Gottlieb, S. S. (2006). Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. American Heart Journal, 152, 940.e1-940.e8.

    Google Scholar 

  • Garin, O., Ferrer, M., Pont, A., Rue, M., Kotzeva, A., Wiklund, I., et al. (2009). Disease-specific health-related quality of life questionnaires for heart failure: A systematic review with meta-analyses. Quality of Life Research, 18, 71–85.

    Article  PubMed  Google Scholar 

  • Haworth, J. E., Moniz-Cook, E., Clark, A. L., Want, M., Waddington, R., & Cleland, J. G. F. (2005). Prevalence and predictors of anxiety and depression in a sample to chronic heart failure patients with left ventricular systolic dysfunction. The European Journal of Heart Failure, 7, 803–808.

    Article  CAS  Google Scholar 

  • Jackson, J. L., & Emery, C. F. (2011). Illness knowledge moderates the influence of coping style on quality of life among women with congestive heart failure. Heart and Lung, 40, 122–129.

    Article  PubMed  Google Scholar 

  • Jiang, W., Kuchibhatla, M., Cuffe, M. S., Christopher, E. J., Alexander, J. D., Clary, G. L., et al. (2004). Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation, 110, 3452–3456.

    Article  PubMed  CAS  Google Scholar 

  • Juenger, J., Schellberg, D., Kraemer, S., Haunstetter, A., Zugck, C., Herzog, W., et al. (2002). Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart, 87, 235–241.

    Article  PubMed  CAS  Google Scholar 

  • Klein, K. M., Turvey, C. L., & Pies, C. J. (2007). Relationship of coping styles with quality of life and depressive symptoms in older heart failure patients. Journal of Aging and Health, 19, 22–38.

    Article  PubMed  Google Scholar 

  • Konstam, V., Salem, D., Pouleur, H., Kostis, J., Gorkin, L., Shumaker, S., et al. (1996). Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. American Journal of Cardiology, 78, 890–895.

    Article  PubMed  CAS  Google Scholar 

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Luyster, F. S., Hughes, J. W., & Gunstad, J. (2009). Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator. Journal of Cardiovascular Nursing, 24, 10–17.

    PubMed  Google Scholar 

  • Martin, C. R., Lewin, R. J. P., & Thompson, D. R. (2003). A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Research, 120, 85–94.

    Google Scholar 

  • Murberg, T. A., Furze, G., & Bru, E. (2004). Avoidance coping styles predict mortality among patients with congestive heart failure: A 6-year follow-up study. Personality and Individual Differences, 36, 757–766.

    Article  Google Scholar 

  • Park, C. L., Folkman, S., & Bostrom, A. (2001). Appraisals of controllability and coping in caregivers and HIV+ men: Testing the goodness-of-fit hypothesis. Journal of Consulting and Clinical Psychology, 69, 481–488.

    Article  PubMed  CAS  Google Scholar 

  • Peyrot, M. F., & McMurry, J. F. (1992). Stress buffering and glycemic control: The role of coping styles. Diabetes Care, 15, 842–846.

    Article  PubMed  CAS  Google Scholar 

  • Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo controlled trial of pimobendan. Pimobendan Multicenter Research Group. American Heart Journal, 124, 1017–1025.

    Article  PubMed  CAS  Google Scholar 

  • Rector, T. S., Kubo, S. H., & Cohn, J. N. (1987). Patients’ self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure, 3, 198–209.

    Google Scholar 

  • Rodriguez-Artalejo, F., Guallar-Castillon, P., Rodriguez Pascual, C., Montoto Otero, C., Monies, A. O., Garcia, A. N., et al. (2005). Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Archives of Internal Medicine, 165, 1274–1279.

    Article  PubMed  Google Scholar 

  • Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. Journal of the American College of Cardiology, 45, 637–651.

    Article  PubMed  Google Scholar 

  • Shen, B. J., Eisenberg, S. A., Maeda, U., Farrell, K., Schwarz, E. R., Penedo, F., et al. (2011). Depression and anxiety predict the decline of physical functioning over six months in patients with heart failure. Annals of Behavioral Medicine, 41, 373–382.

    Google Scholar 

  • Shen, B. J., McCreary, C. P., & Myers, H. F. (2004). Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning among patients in cardiac rehabilitation. Journal of Behavioral Medicine, 27, 39–62.

    Article  PubMed  Google Scholar 

  • Suls, J., & Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.

    Article  PubMed  CAS  Google Scholar 

  • Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377–401.

    Article  PubMed  Google Scholar 

  • Tsuchihashi-Makaya, M., Kato, N., Chishaki, A., Takeshita, A., & Tsutsui, H. (2009). Anxiety and poor social support are independently associated with adverse outcomes in patients with mild heart failure. Circulation Journal, 73, 280–287.

    Article  PubMed  Google Scholar 

  • Volz, A., Schmid, J. P., Zwahlen, M., Kohls, S., Saner, H., & Barth, J. (2011). Predictors of readmission and health related quality of life in patients with chronic heart failure: A comparison of different psychosocial aspects. Journal of Behavioral Medicine, 34, 13–22.

    Article  PubMed  Google Scholar 

  • Wheaton, B. (1985). Models for the stress-buffering functions of coping resources. Journal of Health and Social Behavior, 26, 352–364.

    Article  PubMed  CAS  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by a grant from the American Heart Association.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Biing-Jiun Shen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eisenberg, S.A., Shen, BJ., Schwarz, E.R. et al. Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients. J Behav Med 35, 253–261 (2012). https://doi.org/10.1007/s10865-011-9358-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9358-0

Keywords

Navigation