Effect of negative attributions on depressive symptoms of patients with coronary heart disease after controlling for physical functional impairment.

Objectives Negative attributional style (NAS), or tendency to explain negative events through internal, stable, and global causes, has proved to be an important predictor of depressive symptoms and poor health, including coronary heart disease (CHD). The goal of this two-wave longitudinal study was to look at whether depressive symptoms are caused by or are a consequence of this style in a sample of patients with CHD while controlling for the effect of physical functional impairment on the development of these symptoms. Methods Ninety-one patients, who had just suffered a first cardiac episode, were evaluated on NAS, depressive symptoms and functional capacity (measured in metabolic equivalent levels or METs) both on the first and on last day of an 8-week cardiac rehabilitation programme. Results Globality dimension of NAS at Time 1 predicted depressive symptoms at Time 2 after controlling for both depressive symptoms and METs at Time 1. However, depressive symptoms at Time 1 could not predict any dimension of this style at Time 2. Conclusions These results seem to support that negative attributions about the disease are one of the causes contributing to the development of depression and not a consequence of it, and also suggest that intervention programme should be aimed not only at reducing depressive symptoms, but also at replacing stable and global attributions of negative situations with more unstable and specific explanations. Statement of contribution What is already known on this subject? Negative attributional style (NAS) is an important predictor of depressive symptoms. Depressive symptoms worsen the diagnosis of coronary heart disease (CHD) patients. What does this study add? Globality dimension predicts depression in patients with CHD after controlling for functional capacity. Negative attributions contribute to the development of depression and are not a consequence of it.