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Updated: Sep 13, 2025

Assessment of Stress Effects on Cognitive Flexibility using an Operant Strategy Shifting Paradigm
Published on: May 4, 2020
Relationship Between Perceived Stress Level, Psychological Flexibility, Depression, and Anxiety in Patients with
Esra Polat1, Şükrü Çiriş1, Zekiye Çelikbas2
1Department of Cardiology, Gaziantep City Hospital, Gaziantep 27470, Turkey.
Abstract:
Background and Objectives: Stress and type A personality are known to be risk factors for the development of acute myocardial infarction (AMI), and depression is both a risk factor for AMI and a prognostic factor. In this study, we aimed to evaluate the relationship between psychological flexibility, perceived stress level, depression, and anxiety in AMI patients. Material and Methods: The study included 89 patients with a diagnosis of AMI and 89 volunteer participants with no previous history of coronary angiography and no diagnosis of AMI. Patients were evaluated with the Acceptance and Action Questionnaire (AAQ)-II, the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale (PSS)-14. Results: A strong positive statistically significant correlation was found between the Perceived Stress Scale score and HAD-II (r = 0.697 p < 0.001), HAD-Anxiety (r = 0.715 p < 0.001), and HAD-Depression (r = 0.657 p < 0.001) scores. A statistically significant moderate positive correlation was found between the HAD-Depression Scale and HAD-Anxiety (r = 0.593 p < 0.001) and AAQ-II (r = 0.530 p < 0.001) scores. A strong positive statistically significant correlation was found between the HAD-Anxiety Scale and AAQ-II (r = 0.809 p < 0.001) scores. Conclusions: Investigation of psychological flexibility, anxiety, and depression in AMI patients with scales such as AAQ-II, PSS-14, and HADS may help early diagnosis and treatment of individuals at risk for psychiatric disorders.
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