The relationship between psychological states and health perception in individuals at risk for cardiovascular disease

Kyoung Suk Lee,1 Frances J Feltner,2 Alison L Bailey,3 Terry A Lennie,4 Misook L Chung,4 Brittany L Smalls,5 Donna L Schuman,6 Debra K Moser41College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea; 2University of Kentucky, Family and Community Medicine, Lexington, KY, USA; 3University of Tennessee COM Chattanooga, Erlanger Health System, Chattanooga, TN, USA; 4College of Nursing, University of Kentucky, Lexington, KY, USA; 5College of Medicine Center for Health Service Research, University of Kentucky, Lexington, KY, USA; 6University of Kentucky, College of Social Work, Lexington, KY, USABackgrounds: Perceptions of health are important to motivate people to change behaviors. Non-adherence to healthy behaviors that prevent cardiovascular disease may result from inadequate health perceptions. However, there are few studies investigating relationships between health perceptions and psychological states.Objective: To determine whether psychological states (ie, depressive symptoms and anxiety) are associated with the congruency between health perception and estimated risk for cardiovascular disease in adults with 2 or more cardiovascular disease risk factors.Methods: Community dwellers at risk for cardiovascular disease were asked to complete the Patient Health Questionnaire-9 and the anxiety subscale of the Brief Symptom Inventory to measure depressive symptoms and anxiety, respectively. Participants rated their perceived health from excellent to poor. The estimated cardiovascular disease risks were measured with the 10-year cardiovascular disease Framingham risk scores. Participants were grouped into three health perception groups based on congruency between levels of health perception and cardiovascular disease risk. Multivariate multinomial logistic regression was done to examine the association between psychological states and health perception groups.Results: Of 828 participants 54.7%, 12.0%, and 33.3% had congruent, pessimistically biased, and optimistically biased health perception, respectively. Depressive symptoms were significantly associated with pessimistic bias (adjusted odds ratio: 1.070, 95% confidence interval 1.010–1.133), but not anxiety. Optimistic bias was not associated with either depressive symptoms or anxiety.Conclusions: A mismatch between individual health perceptions and cardiovascular disease risks was associated with depressive symptoms. As health perception is affected by depressive symptoms, clinicians should assess depressive symptoms when exploring health perceptions and engaging individuals in decision-making about a healthy lifestyle.Keywords: emotion, perception, cardiovascular diseases, healthy lifestyl