Health Anxiety and Quality of Life Among Patients With Cardiovascular Disease: The Mediating Role of Emotion Regulation Difficulties
Keywords:
Health anxiety, Quality of life, Cardiovascular disease, Emotion regulation difficulties, Mediation, Cardiac patientsAbstract
Objective: This study aimed to investigate the relationship between health anxiety and quality of life among patients with cardiovascular disease and to examine the mediating role of emotion regulation difficulties in this relationship.
Methods and Materials: This descriptive-correlational cross-sectional study was conducted on 312 patients with cardiovascular disease who were receiving outpatient cardiology follow-up or cardiac rehabilitation services in Germany. Participants were selected through purposive sampling based on the inclusion and exclusion criteria. Data were collected using a demographic and clinical information form, the Short Health Anxiety Inventory, the Difficulties in Emotion Regulation Scale, and the MacNew Heart Disease Health-Related Quality of Life Questionnaire. Data were analyzed using SPSS and AMOS. Pearson correlation coefficients were used to examine relationships among variables, and path analysis was conducted to test the mediation model. The significance of the indirect effect was assessed using the bootstrapping method with 5,000 resamples and 95% confidence intervals.
Findings: Health anxiety was significantly and positively correlated with emotion regulation difficulties (r = 0.58, p < .01) and significantly and negatively correlated with quality of life (r = -0.49, p < .01). Emotion regulation difficulties were also significantly and negatively correlated with quality of life (r = -0.62, p < .01). The mediation model showed acceptable fit indices (χ²/df = 2.16, CFI = 0.989, TLI = 0.963, RMSEA = 0.061, SRMR = 0.018). Health anxiety significantly predicted emotion regulation difficulties (β = 0.56, p < .001), and emotion regulation difficulties significantly predicted quality of life (β = -0.47, p < .001). The direct effect of health anxiety on quality of life remained significant (β = -0.25, p < .001). The indirect effect was also significant (β = -0.27, 95% CI [-0.042, -0.022]), indicating partial mediation.
Conclusion: Emotion regulation difficulties partially mediated the relationship between health anxiety and quality of life among patients with cardiovascular disease, suggesting that emotional dysregulation is an important psychological mechanism through which health anxiety may reduce perceived quality of life.
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Copyright (c) 2025 Francesca Lombardi (Author); Florian Reimann
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