Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review

      Highlights

      • Systematic review examining positive psychological constructs and health outcomes
      • Included 30 studies involving over 14,000 patients with known heart disease
      • Positive constructs were frequently associated with favorable health outcomes.
      • Significant relationships typically remained after covariate adjustment.
      • Exploratory meta-analysis using subset of studies had similar findings.

      Abstract

      Depression and anxiety are well-known to be associated with adverse health outcomes in cardiac patients. However, there has been less work synthesizing the effects of positive psychological constructs (e.g., optimism) on health-related outcomes in cardiac patients. We completed a systematic review of prospective observational studies using established guidelines. A search of PubMed and PsycINFO databases from inception to January 2014 was used to identify articles. To be eligible, studies were required to assess effects of a positive psychological construct on subsequent health-related outcomes (including mortality, rehospitalizations, self-reported health status) in patients with established heart disease. Exploratory random effects' meta-analyses were performed on the subset of studies examining mortality or rehospitalizations. Seventy-seven analyses from 30 eligible studies (N = 14,624) were identified. Among studies with 100 or more participants, 65.0% of all analyses and 64.7% of analyses adjusting for one or more covariates reported a significant (p < .05) association between positive psychological constructs and subsequent health outcomes. An exploratory meta-analysis of 11 studies showed that positive constructs were associated with reduced rates of rehospitalization or mortality in unadjusted (odds ratio = .87; 95% confidence interval [.83, .92]; p < .001) and adjusted analyses (odds ratio = .89; 95% confidence interval [.84, .91]; p < .001); there was little suggestion of publication bias. Among cardiac patients, positive psychological constructs appear to be prospectively associated with health outcomes in most but not all studies. Additional work is needed to identify which constructs are most important to cardiac health, and whether interventions can cultivate positive attributes and improve clinical outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Blaha M.J.
        • et al.
        Heart disease and stroke statistics—2014 update: a report from the american heart association.
        Circulation. 2014; 129: e28-e292
        • Briffa T.G.
        • Hobbs M.S.
        • Tonkin A.
        • Sanfilippo F.M.
        • Hickling S.
        • Ridout S.C.
        • et al.
        Population trends of recurrent coronary heart disease event rates remain high.
        Circ. Cardiovasc. Qual. Outcomes. 2011; 4: 107-113
        • Wulsin L.R.
        • Singal B.M.
        Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review.
        Psychosom. Med. 2003; 65: 201-210
        • Huffman J.C.
        • Celano C.M.
        • Beach S.R.
        • Motiwala S.R.
        • Januzzi J.L.
        Depression and cardiac disease: epidemiology, mechanisms, and diagnosis.
        Cardiovasc. Psychiatry Neurol. 2013; 2013: 695925
        • Lichtman J.H.
        • Froelicher E.S.
        • Blumenthal J.A.
        • Carney R.M.
        • Doering L.V.
        • Frasure-Smith N.
        • et al.
        Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.
        Circulation. 2014; 129: 1350-1369
        • Meijer A.
        • Conradi H.J.
        • Bos E.H.
        • Thombs B.D.
        • van Melle J.P.
        • de Jonge P.
        Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research.
        Gen. Hosp. Psychiatry. 2011; 33: 203-216
        • Roest A.M.
        • Martens E.J.
        • Denollet J.
        • de Jonge P.
        Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis.
        Psychosom. Med. 2010; 72: 563-569
        • Roest A.M.
        • Zuidersma M.
        • de Jonge P.
        Myocardial infarction and generalised anxiety disorder: 10-year follow-up.
        Br. J. Psychiatry. 2012; 200: 324-329
        • Kim E.S.
        • Smith J.
        • Kubzansky L.D.
        Prospective study of the association between dispositional optimism and incident heart failure.
        Circ. Heart Fail. 2014; 7: 394-400
        • Steptoe A.
        • Dockray S.
        • Wardle J.
        Positive affect and psychobiological processes relevant to health.
        J. Pers. 2009; 77: 1747-1776
        • Tindle H.
        • Chang Y.
        • Kuller L.
        • Manson J.
        • Robinson J.
        • Rosal M.
        • et al.
        Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative.
        Circulation. 2009; 120: 656-662
        • Rasmussen H.N.
        • Scheier M.F.
        • Greenhouse J.B.
        Optimism and physical health: a meta-analytic review.
        Ann. Behav. Med. 2009; 37: 239-256
        • Chida Y.
        • Steptoe A.
        Positive psychological well-being and mortality: a quantitative review of prospective observational studies.
        Psychosom. Med. 2008; 70: 741-756
        • Boehm J.K.
        • Kubzansky L.D.
        The heart's content: the association between positive psychological well-being and cardiovascular health.
        Psychol. Bull. 2012; 138: 655-691
        • Pressman S.
        • Cohen S.
        Does positive affect influence health?.
        Psychol. Bull. 2005; 131: 925-971
        • Ryff C.D.
        • Singer B.H.
        • Dienberg Love G.
        Positive health: connecting well-being with biology.
        Philos. Trans. R. Soc. Lond. B Biol. Sci. 2004; 359: 1383-1394
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • Arnett D.K.
        • Blaha M.J.
        • Cushman M.
        • et al.
        Heart disease and stroke statistics—2015 update: a report from the american heart association.
        Circulation. 2015; 131: e29-e322
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • Olkin I.
        • Williamson G.D.
        • Rennie D.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Miller S.A.
        • Forrest J.L.
        Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions.
        J. Evid. Based Dent. Pract. 2001; 1: 136-141
        • Diener E.
        • Suh E.M.
        • Lucas R.E.
        • Smith H.L.
        Subjective well-being: three decades of progress.
        Psychol. Bull. 1999; 125: 276-302
        • Ryff C.D.
        • Keyes C.L.
        The structure of psychological well-being revisited.
        J. Pers. Soc. Psychol. 1995; 69: 719-727
        • Anker S.D.
        • Agewall S.
        • Borggrefe M.
        • Calvert M.
        • Jaime Caro J.
        • Cowie M.R.
        • et al.
        The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials.
        Eur. Heart J. 2014; 35: 2001-2009
        • Jackson N.
        • Waters E.
        • Guidelines for Systematic Reviews in Health P, Public Health T
        Criteria for the systematic review of health promotion and public health interventions.
        Health Promot. Int. 2005; 20: 367-374
        • Juni P.
        • Witschi A.
        • Bloch R.
        • Egger M.
        The hazards of scoring the quality of clinical trials for meta-analysis.
        JAMA. 1999; 282: 1054-1060
        • Greenland S.
        • O'Rourke K.
        On the bias produced by quality scores in meta-analysis, and a hierarchical view of proposed solutions.
        Biostatistics. 2001; 2: 463-471
        • Davoli M.
        • Amato L.
        • Minozzi S.
        • Bargagli A.M.
        • Vecchi S.
        • Perucci C.A.
        Volume and health outcomes: an overview of systematic reviews.
        Epidemiol. Prev. 2005; 29: 3-63
        • Goesling B.
        • Colman S.
        • Trenholm C.
        • Terzian M.
        • Moore K.
        Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: a systematic review.
        J. Adolesc. Health. 2014; 54: 499-507
        • DeGue S.
        • Valle L.A.
        • Holt M.K.
        • Massetti G.M.
        • Matjasko J.L.
        • Tharp A.T.
        A systematic review of primary prevention strategies for sexual violence perpetration.
        Aggress. Violent Behav. 2014; 19: 346-362
        • Maxwell S.E.
        The persistence of underpowered studies in psychological research: causes, consequences, and remedies.
        Psychol. Methods. 2004; 9: 147-163
        • Brouwers C.
        • Mommersteeg P.M.
        • Nyklicek I.
        • Pelle A.J.
        • Westerhuis B.L.
        • Szabo B.M.
        • et al.
        Positive affect dimensions and their association with inflammatory biomarkers in patients with chronic heart failure.
        Biol. Psychol. 2013; 92: 220-226
        • Myaskovsky L.
        • Dew M.A.
        • McNulty M.L.
        • Switzer G.E.
        • DiMartini A.F.
        • Kormos R.L.
        • et al.
        Trajectories of change in quality of life in 12-month survivors of lung or heart transplant.
        Am. J. Transplant. 2006; 6: 1939-1947
        • Shepperd J.A.
        • Maroto J.J.
        • Pbert L.A.
        Dispositional optimism as a predictor of health changes among cardiac patients.
        J. Res. Pers. 1996; 10: 34-42
        • Versteeg H.
        • Pedersen S.S.
        • Erdman R.A.
        • van Nierop J.W.
        • de Jaegere P.
        • van Domburg R.T.
        Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention.
        Qual. Life Res. 2009; 18: 953-960
        • Hoogwegt M.T.
        • Versteeg H.
        • Hansen T.B.
        • Thygesen L.C.
        • Pedersen S.S.
        • Zwisler A.D.
        Exercise mediates the association between positive affect and 5-year mortality in patients with ischemic heart disease.
        Circ. Cardiovasc. Qual. Outcomes. 2013; 6: 559-566
        • Denollet J.
        Emotional distress and fatigue in coronary heart disease: the Global Mood Scale (GMS).
        Psychol. Med. 1993; 23: 111-121
        • Middleton R.A.
        • Byrd E.K.
        Psychosocial factors and hospital readmission status of older persons with cardiovascular disease.
        J. Appl. Rehabil. Couns. 1996; 27: 3-10
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control. Clin. Trials. 1986; 7: 177-188
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        Br. Med. J. 2003; 327: 557-560
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Glazer K.M.
        • Emery C.F.
        • Frid D.J.
        • Banyasz R.E.
        Psychological predictors of adherence and outcomes among patients in cardiac rehabilitation.
        J. Cardiopulm. Rehabil. 2002; 22: 40-46
        • Barefoot J.C.
        • Brummett B.H.
        • Helms M.J.
        • Mark D.B.
        • Siegler I.C.
        • Williams R.B.
        Depressive symptoms and survival of patients with coronary artery disease.
        Psychosom. Med. 2000; 62: 790-795
        • Grunberg G.E.
        • Crater S.W.
        • Green C.L.
        • Seskevich J.
        • Lane J.D.
        • Koenig H.G.
        • et al.
        Correlations between preprocedure mood and clinical outcome in patients undergoing coronary angioplasty.
        Cardiol. Rev. 2003; 11: 309-317
        • Mahler H.I.M.
        • Kulik J.A.
        Optimism, pessimism and recovery from coronary bypass surgery: prediction of affect, pain and functional status.
        Psychol. Health Med. 2000; 5: 347-358
      1. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (Available from www.cochrane-handbook.org)
        • Jowsey S.G.
        • Cutshall S.M.
        • Colligan R.C.
        • Stevens S.R.
        • Kremers W.K.
        • Vasquez A.R.
        • et al.
        Seligman's theory of attributional style: optimism, pessimism, and quality of life after heart transplant.
        Prog. Transplant. 2012; 22: 49-55
        • Ried L.D.
        • Tueth M.J.
        • Handberg E.
        • Nyanteh H.
        Validating a self-report measure of global subjective well-being to predict adverse clinical outcomes.
        Qual. Life Res. 2006; 15: 675-686
        • van der Vlugt M.J.
        • van Domburg R.T.
        • Pedersen S.S.
        • Veerhoek R.J.
        • Leenders I.M.
        • Pop G.A.
        • et al.
        Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction.
        J. Psychosom. Res. 2005; 59: 247-253
        • Denollet J.
        • Pedersen S.S.
        • Daemen J.
        • de Jaegere P.
        • Serruys P.W.
        • van Domburg R.T.
        Reduced positive affect (anhedonia) predicts major clinical events following implantation of coronary-artery stents.
        J. Intern. Med. 2008; 263: 203-211
        • Hoen P.W.
        • Denollet J.
        • de Jonge P.
        • Whooley M.A.
        Positive affect and survival in patients with stable coronary heart disease: findings from the Heart and Soul Study.
        J. Clin. Psychiatry. 2013; 74: 716-722
        • Brummett B.H.
        • Boyle S.H.
        • Siegler I.C.
        • Williams R.B.
        • Mark D.B.
        • Barefoot J.C.
        Ratings of positive and depressive emotion as predictors of mortality in coronary patients.
        Int. J. Cardiol. 2005; 100: 213-216
        • van den Broek K.C.
        • Tekle F.B.
        • Habibovic M.
        • Alings M.
        • van der Voort P.H.
        • Denollet J.
        Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator.
        Int. J. Cardiol. 2013; 165: 327-332
        • Sirri L.
        • Potena L.
        • Masetti M.
        • Tossani E.
        • Magelli C.
        • Grandi S.
        Psychological predictors of mortality in heart transplanted patients: a prospective, 6-year follow-up study.
        Transplantation. 2010; 89: 879-886
        • Scheier M.F.
        • Matthews K.A.
        • Owens J.F.
        • Schulz R.
        • Bridges M.W.
        • Magovern G.J.
        • et al.
        Optimism and rehospitalization after coronary artery bypass graft surgery.
        Arch. Intern. Med. 1999; 159: 829-835
        • Tindle H.
        • Belnap B.H.
        • Houck P.R.
        • Mazumdar S.
        • Scheier M.F.
        • Matthews K.A.
        • et al.
        Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
        Psychosom. Med. 2012; 74: 200-207
        • Helgeson V.S.
        Cognitive adaptation, psychological adjustment, and disease progression among angioplasty patients: 4 years later.
        Health Psychol. 2003; 22: 30-38
        • Hevey D.
        • McGee H.M.
        • Horgan J.H.
        Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later.
        J. Behav. Med. 2014; 37: 300-307
        • Kim E.S.
        • Sun J.K.
        • Park N.
        • Kubzansky L.D.
        • Peterson C.
        Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up.
        J. Behav. Med. 2013; 36: 124-133
        • Scheier M.F.
        • Matthews K.A.
        • Owens J.F.
        • Magovern Sr., G.J.
        • Lefebvre R.C.
        • Abbott R.A.
        • et al.
        Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being.
        J. Pers. Soc. Psychol. 1989; 57: 1024-1040
        • Fitzgerald T.E.
        • Prochaska J.O.
        • Pransky G.S.
        Health risk reduction and functional restoration following coronary revascularization: a prospective investigation using dynamic stage typology clustering.
        Int. J. Rehabil. Health. 2000; 5: 99-116
        • Watson D.
        • Clark L.A.
        • Tellegen A.
        Development and validation of brief measures of positive and negative affect: the PANAS scales.
        J. Pers. Soc. Psychol. 1988; 54: 1063-1070
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr. Scand. 1983; 67: 361-370
        • Brummett B.H.
        • Morey M.C.
        • Boyle S.H.
        • Mark D.B.
        Prospective study of associations among positive emotion and functional status in older patients with coronary artery disease.
        J. Gerontol. B Psychol. Sci. Soc. Sci. 2009; 64: 461-469
        • Echteld M.A.
        • van Elderen T.
        • van der Kamp L.J.
        Modeling predictors of quality of life after coronary angioplasty.
        Ann. Behav. Med. 2003; 26: 49-60
        • Pelle A.J.
        • Pedersen S.S.
        • Szabo B.M.
        • Denollet J.
        Beyond Type D personality: reduced positive affect (anhedonia) predicts impaired health status in chronic heart failure.
        Qual. Life Res. 2009; 18: 689-698
        • Jenkins C.D.
        • Stanton B.A.
        • Jono R.T.
        Quantifying and predicting recovery after heart surgery.
        Psychosom. Med. 1994; 56: 203-212
        • Jenkins D.
        • Jono R.T.
        • Stanton B.A.
        Predicting completeness of symptom relief after major heart surgery.
        Behav. Med. 1996; 22: 45-57
        • Desai A.S.
        • Stevenson L.W.
        Rehospitalization for heart failure: predict or prevent?.
        Circulation. 2012; 126: 501-506
        • Kolansky D.M.
        Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden.
        Am. J. Manag. Care. 2009; 15: S36-S41
        • Rozanski A.
        Optimism and other sources of psychological well-being: a new target for cardiac disease prevention.
        Circ. Heart Fail. 2014; 7: 385-387
        • DuBois C.
        • Beach S.
        • Kashdan T.
        • Nyer M.
        • Park E.
        • Celano C.
        • et al.
        Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions.
        Psychosomatics. 2012; 53: 303-318
        • Tindle H.
        • Davis E.
        • Kuller L.
        Attitudes and cardiovascular disease.
        Maturitas. 2010; 67: 108-113
        • Giltay E.J.
        • Geleijnse J.M.
        • Zitman F.G.
        • Buijsse B.
        • Kromhout D.
        Lifestyle and dietary correlates of dispositional optimism in men: the Zutphen Elderly Study.
        J. Psychosom. Res. 2007; 63: 483-490
        • Boehm J.K.
        • Williams D.R.
        • Rimm E.B.
        • Ryff C.
        • Kubzansky L.D.
        Association between optimism and serum antioxidants in the midlife in the United States study.
        Psychosom. Med. 2013; 75: 2-10
        • Huffman J.C.
        • Mastromauro C.A.
        • Boehm J.K.
        • Seabrook R.
        • Fricchione G.L.
        • Denninger J.W.
        • et al.
        Development of a positive psychology intervention for patients with acute cardiovascular disease.
        Heart Int. 2011; 6: e14
        • Ogedegbe G.O.
        • Boutin-Foster C.
        • Wells M.T.
        • Allegrante J.P.
        • Isen A.M.
        • Jobe J.B.
        • et al.
        A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans.
        Arch. Intern. Med. 2012; 172: 322-326
        • Peterson J.C.
        • Charlson M.E.
        • Hoffman Z.
        • Wells M.T.
        • Wong S.C.
        • Hollenberg J.P.
        • et al.
        A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.
        Arch. Intern. Med. 2012; 172: 329-336