Fattori psicologici associati alle malattie cardiovascolari. Differenze tra condizioni acute e croniche e impatto della gravità della malattia sul benessere del paziente

This thesis is devoted to the study of psychological factors associated with cardiovascular diseases. It is made up by five theoretical chapters and four empirical studies. The first chapter presents a brief description of the different cardiovascular diseases that are still the main cause of death and disability in Western countries. The second chapter is focused on the role of psychology with respect to the different cardiovascular diseases. It ranges from the psychosomatic approach, branch of medicine interested in organic disorders without an anatomic lesion or functional problems, to the most recent area of psychocardiology. The third chapter is on the Type A Behavior Pattern, on the variables of hostility and anger, and on type D personality. It deals with a description of these factors, an evaluation of the methods mostly used for their assessment, and the main empirical findings relative to the association with cardiovascular disease; the hypothesized physiological mechanisms behind these relationships have been also addressed. The fourth chapter is devoted to depression and anxiety as crucial variables which can predict cardiovascular diseases and a worse prognosis in already present diseases; methods and instruments of their evaluation are also presented, together with the main findings on their association with cardiovascular disease and associated physiological and behavioral mechanisms. The fifth chapter is focused on the psychological factors that exert a protective against cardiovascular diseases, namely self-efficacy beliefs, representation of illness, and perceived social support; also for these variables evaluation methods and main findings from the literature are presented. The first study compared the psychological profile of a group of patients with cardiovascular disease with a “healthy” group, not affected by cardiovascular diseases. Similarly to previous research, our results showed significant differences in some dimensions of Type A Behavior Pattern, as well as in anxiety and depression. The second study compared the psychological profiles of patients with different cardiovascular diseases, differentiating between acute and chronic diagnosis. Results showed important differences between the two groups in some of the dimensions of Type A behavior pattern, in social withdrawal, anxiety, depression, subjective wellbeing, perceived social support, perception of illness, and self-efficacy beliefs in managing the disease.The third study investigated, with a cross-sectional research design, the role of the representations of illness and self-efficacy beliefs in the impact exerted by the severity of illness on health satisfaction, depression and life satisfaction of patients with cardiovascular diseases. Self-efficacy beliefs and representation of illness were found to be valid mediators of the relationship between the objective indicator of illness severity and the different indicators of patient’s well-being. The fourth study was aimed at investigating longitudinally, through a two-monthsstudy, the role of illness representations, self-efficacy beliefs, and perceived social support in mediating the impact of illness severity on depression. In line with previous research, our results confirmed the relevant role of the three protective factors.