title: Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review.
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.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Christina M
authors.initials: CM
authors.lastname: DuBois
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Oriana Vesga
authors.initials: OV
authors.lastname: Lopez
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Beale
authors.affiliation: Harvard Medical School, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.affiliation: Department of Psychology, Chapman University, Orange, CA, United States.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Boehm
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States. Electronic address: jhuffman@partners.org.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000523:psychology*; D006801:Humans; D000067656:Optimism; D018434:Sickness Impact Profile; D016896:Treatment Outcome
keywords: Cardiovascular disease; Coronary artery disease; Optimism; Positive affect; Systematic review; Well-being