Association between psychological inflexibility, distress and health-related quality of life in people with cardiovascular disease

Psychological inflexibility (PIF), the inability to adapt to changing circumstances and engage in behaviors that are consistent with one's values, has been associated with distress and impaired quality of life. To date only a paucity of studies have examined the role of PIF in people with cardiovascular disease. Hence, the current study will examine the association between PIF and depression, anxiety, and health-related quality of life in a large, prospective, Dutch, cardiac sample. A total of N = 302 cardiac patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. Data were collected at baseline, 3- and 6-months follow-up using online questionnaires. Pearson's correlation and Linear Mixed Models (LMM) analysis was performed to answer the research question. The mean age of the sample was 64 ± 10 and N = 111(37 %) were females. Results showed that at baseline, PIF correlated positively with depression ( r = 0.58) and anxiety ( r = 0.64) symptoms, and negatively with both health-related quality of life subscales (MCS r = −0.56; PCS r = −0.27). After adjusting for covariate, LMM showed that, over time, PIF was positively associated with depression (B = 0.32; p < .001), anxiety (B = 0.32;p < .001), and negatively with Mental (B = -0.81; p < .001) and Physical Component Scale (B = -0.45; p < .001). This is the first prospective study to examine the association between PIF and mental health in cardiac patients. Results showed that PIF was positively associated with depression and anxiety symptoms and negatively with health-related quality of life. Intervention studies are needed to examine whether decreasing PIF associates with a decrease in distress and increase in health-related quality of life. • Psychological inflexibility is a risk factor for impaired mental health. • Psychological inflexibility is associated with higher distress levels. • Psychological inflexibility is associated with lower health-related quality of life. • Interventions to increase psychological flexibility are warranted.