Psychosocial factors and assessment in cardiac rehabilitation

Understanding the unique impact of psychosocial factors on the development and progression of coronary heart disease (CHD) has significant implications for cardiac rehabilitation (CR). Recent guidelines for CR strongly recommend the assessment of psychosocial factors and provision of behavioral interventions for CR participants. In this review, we focus on the most prominent psychosocial issues in CR literature, namely depression, anxiety, social support, and cardiac-prone personality. First, we summarize the current empirical findings with regard to each of the psychosocial issues in CR. In addition, we provide recommendations for some of the most common or useful instruments for assessing these psychosocial factors in CR settings. The results show that anxiety and depression are, in general, prevalent among CR participants, and that CR appears to be effective in reducing these distressful symptoms as well as coronary-prone behaviors. There is some evidence suggesting that higher anxiety and depression as well as a lack of social support may prevent cardiac patients from attending CR or predict non-adherence and premature dropout in CR participants. The generalizability of these findings, however, may be compromised by several methodological issues, including relatively small samples, low representation of women in studies, and lack of rigorous statistical controls. Future research is needed to investigate the specific role of each psychosocial factor in the context of rehabilitation.