Health locus of control and cardiovascular risk: A serial mediation analysis

Cardiovascular disease is the leading cause of death worldwide. Health locus of control (HLOC), defined as the degree to which an individual believes they influence health outcomes, has been linked to cardiovascular risk. Yet few studies have examined the mechanisms that explain this relationship.

Grounded in the biopsychosocial framework and health beliefs model, the present study explored the longitudinal serial mediation role of self-esteem and pessimism in the relationship between HLOC and cardiovascular risk. Data from the Midlife in the United States study were used. The sample consisted of 517 participants, with the majority identifying as female (57.3%) and White (93.9%).

The longitudinal serial mediation revealed that HLOC at timepoint 1 (T1) significantly predicted cardiovascular risk at timepoint 3 (T3), with this pathway partially mediated by self-esteem as mediator 1 (M1) and pessimism as mediator 2 (M2). Participants with greater internal HLOC beliefs had higher self-esteem, endorsed less pessimistic beliefs, and experienced lower cardiovascular risk.

These findings highlight the impact of control-related beliefs on cardiovascular health, suggesting that psychological mechanisms, including self-esteem and outlook beliefs, influence engagement in health-promoting behaviors and subsequent health outcomes. This underscores the importance of their inclusion in the assessment and treatment of cardiovascular disease. (PsycInfo Database Record (c) 2026 APA, all rights reserved).