The Impact of Illness Perception on Adherence in Coronary Heart Patient: The Mediating Role of Heart-Focused Anxiety and Depression

摘要

In Indonesia, following stroke, coronary heart disease is the highest cause of mortality at all ages, approximately 12.9%. Treatment recommendations for cardiac disease include medication and lifestyle changes that need close patient adherence. Non-adherence is likely to worsen patient conditions, yet it is common among chronic illness patients. One model to explain adherence is Leventhal's Common Sense Self-Regulation Model (CSM), in which patients' perception and belief about their disease and treatment can affect adherence. Illness perception can affect patients' emotional response and coping behaviors such as adherence to medical recommendation, thus denoting the importance of assessing patients' illness perception and their psychological distress such as anxiety and depression. Heart-focused anxiety is a specific type of anxiety, a term used to describe fear of stimulus and sensation connected to the heart because of individual perception of negative consequences. Psychological distress among cardiac patients also includes depression, which is associated with impaired subsequent adherence behavior. Although CSM is commonly used, there is a dearth of its use in explaining adherence in coronary heart disease in Indonesia. This study used the CSM model to explain adherence in coronary heart disease patients by assessing the predictors of illness perception and heart-focused anxiety and depression. This pilot study had a cross-sectional design with 55 participants (age range: 28-81 years, 56% male), diagnosed with coronary heart disease for more than 1 year. Offline and online data collection used the Morisky Medication Adherence Scale (MMAS-8) and Lifestyle Adherence Measure (LAM) as measurements for adherence, the Cardiac Anxiety Questionnaire (CAQ) as measurement for heart-focused anxiety, the Patient Health Questionnaire (PHQ-4) for depression screening, and the Brief Illness Perception Questionnaire (Brief-IPQ) to measure illness perception. Means for the CAQ, BRIEF-IPQ, and the PHQ (Depression subtest) were 2.39 (SD = .51), 5.17 (SD = .95), and 1.18 (SD = 1.11), respectively. The cut-off score for the PHQ was ≥ 3; thus 10.91% of participants had depressive symptoms. Means for MMAS-8 and LAM were 4.25 (SD = 1.48) (low medication adherence) and 4.93 (SD = 1.33) (medium lifestyle adherence). Predictors did not significantly predict the DV (p = ns).