Abstract / Summary
Abstract Background Psychological distress significantly impacts clinical outcomes in cardiac populations, yet the structural pathways from cognitive illness representations to psychological outcomes remain under-explored. Guided by Leventhal’s Common-Sense Model of Self-Regulation, this study examined the structural pathways linking illness perceptions to anxiety and depressive symptoms in patients with heart disease. Methods This cross-sectional study included 264 elderly cardiac patients (mean age: 69.83 ± 7.80 years) in Iran. Data were collected using the Brief Illness Perception Questionnaire (Brief-IPQ) and the Hospital Anxiety and Depression Scale (HADS). Hypothesized pathways were examined using structural equation modeling (SEM). Results High prevalence rates of depressive (58.7%) and anxiety (54.5%) symptoms were observed. The structural model demonstrated excellent goodness-of-fit (χ²/df = 1.92, CFI = 0.958, TLI = 0.951, RMSEA = 0.058, SRMR = 0.045). Illness identity positively predicted both anxiety (β = 0.183, p < .001) and depression (β = 0.204, p < .001). Perceived consequences selectively predicted depression (β = 0.238, p < .001). Conversely, personal control functioned as a protective negative predictor for both anxiety (β = -0.211, p < .001) and depression (β = -0.245, p < .001). A significant positive correlation existed between latent anxiety and depression (β = 0.298, p < .001). Conclusions Illness representations function as distinct cognitive drivers of emotional distress. While symptom identity and perceived consequences amplify vulnerability, personal control acts as a critical protective buffer. Integrating cognitive reframing and control-enhancing strategies into cardiac patient care pathways may effectively mitigate psychological comorbidity.