title: Overlap and distinctiveness of psychological risk factors in patients with ischemic heart disease and chronic heart failure: are we there yet?
abstract: OBJECTIVE
  Growing evidence supports the importance of psychological factors in the etiology and progression of cardiovascular disease (CVD). However, this research has been criticized due to overlap between psychological constructs. We examined whether psychological questionnaires frequently used in cardiovascular research assess distinct constructs in a mixed group of ischemic heart disease (IHD) and chronic heart failure (CHF) patients.
  
  
  METHODS
  565 patients with CHF (n=118) or IHD (n=447) completed the Type D scale (DS14), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and State Trait Anxiety Inventory (STAI). Pearson product moment correlations were computed to determine the interrelatedness between psychological constructs. Principal component analyses (PCA) were conducted on both scale scores and items to determine higher-order constructs and distinctiveness of psychological questionnaires.
  
  
  RESULTS
  Two higher-order constructs were identified, namely negative affect and social inhibition. PCA on all 69 items showed that anxiety, depression, negative affectivity, and social inhibition were distinct constructs. The original structure of the DS14 was confirmed, whereas items of the HADS and BDI loaded more diffusely; items of the STAI reflected two different components.
  
  
  CONCLUSIONS
  The use of multiple questionnaires in cardiac patients is justified, as the higher order construct negative affect comprised different facets. Social inhibition was also shown to be a distinct construct, indicating that it may timely for cardiovascular research to look at the role of inhibition in addition to negative emotions. Future studies are warranted to determine whether these findings are replicable in other cardiac samples and to specify the unique prognostic value of these psychological facets.
authors.affiliation: Tilburg University, CoRPS-Center of Research on Psychology in Somatic Disease, The Netherlands.
authors.forename: Aline J
authors.initials: AJ
authors.lastname: Pelle
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
mesh_terms: D000339:Affect; D000368:Aged; D002908:Chronic Disease; D005163:Factor Analysis, Statistical; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D012919:Social Behavior; D011795:Surveys and Questionnaires