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Examining Cognitive Coping and Its Impact on Information Seeking, Information Satisfaction, and Quality of Life in Female Coronary Artery Disease Patients
*Corresponding author: Apoorva Goel, Department of Clinical Psychology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. apoorvagoel1999@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Goel A, Kaur G, Upadhyay P, Kumar P, Mishra BP. Examining Cognitive Coping and Its Impact on Information Seeking, Information Satisfaction, and Quality of Life in Female Coronary Artery Disease Patients. Indian J Cardiovasc Dis Women. 2025;10:192-8. doi: 10.25259/IJCDW_98_2024
Abstract
Objectives:
The study aimed to evaluate the gender differences in coping style, depression, anxiety, stress, information satisfaction, and quality of life in coronary artery disease (CAD) patients.
Materials and Methods:
The current study included 40 CAD patients enrolled in a time-based study conducted between May 2024 and September 2024. The participants were administered questionnaires focusing on cognitive coping style, information satisfaction, quality of life, and psychological distress. P < 0.05 was considered statistically significant.
Results:
The results found gender differences in levels of depression and anxiety in CAD patients (t =1.793, P = 0.040; t = 2.204, P = 0.016). Patients with monitoring coping style were found to have higher levels of stress, depression, and anxiety as compared to patients with blunting coping style (P < 0.001). The study also found a 7.23% variance in psychological distress due to age, which indicates that older patients show slightly lower psychological distress.
Conclusion:
The study addresses a critical gap in research on gender-specific experiences as well as the inclusion of individual factors such as coping style in managing distress associated with coronary artery disease.
Keywords
Cognitive Coping
Information Satisfaction
Quality of Life
ABSTRACT IMAGE
INTRODUCTION
Coronary artery disease (CAD) is a common cardiovascular disorder characterized by the accumulation of atherosclerotic plaques within the coronary arteries, resulting in luminal narrowing and compromised myocardial blood supply.[1] In India, the prevalence of CAD is notably higher among individuals with diabetes (21.4%) compared to those without diabetes (11.4%), with additional risk factors including hypertension, obesity, and smoking contributing to its incidence.[2] Beyond the physical manifestations, CAD imposes a substantial psychological burden, with anxiety and depression affecting approximately 20–50% and 20–45% of patients, respectively.[3] The interplay between psychological distress and CAD involves complex physiological and psychological mechanisms, where factors such as type D personality and reduced use of adaptive coping strategies like planning have been associated with increased depression in this population.[4] Furthermore, CAD patients frequently report diminished health-related quality of life (HRQoL) across both physical and psychological domains.[5]
The doctor-patient relationship has evolved significantly with the advent of smartphones and widespread internet accessibility, leading to increased patient engagement in health information seeking.[6] Cognitive coping styles in response to threatening medical information are broadly categorized into monitoring (information-seeking) and blunting (information-avoidance) strategies.[7] Individuals exhibiting a monitoring style actively seek and focus on threatening cues, whereas those with a blunting style tend to avoid such information and distract themselves from the threat. Previous research has explored these coping styles in various clinical populations, including patients with gastrointestinal stromal tumors and hypothetical cancer diagnoses, revealing that monitors often experience greater emotional distress and lower satisfaction with information, despite a preference for more detailed information.[8,9]
Despite these insights, research examining the influence of cognitive coping styles on psychological distress, information satisfaction questionnaire (ISQ), and health-HRQoL specifically among CAD patients remains limited and fragmented. The present study aims to address this gap by investigating gender differences in these variables within a CAD population.
MATERIALS AND METHODS
This cross-sectional study was conducted at a tertiary care hospital in North India between May and September 2024. The study received approval from the Institutional Ethics Committee of Dayanand Medical College and Hospital (No. DMC/IEC/2024/332). Participants included individuals diagnosed with CAD who presented to the hospital during the study period. No sample size calculation was performed, as the study was time-based. A total of 40 participants (20 males and 20 females) were enrolled, with both groups matched for age and educational qualification. Purposive sampling was employed, including only those individuals who met the inclusion criteria and provided informed consent.
Inclusion criteria involved individuals above the age of 18 years, diagnosed with CAD, educated up to primary grade level, and willing to give informed consent for participation. Individuals presenting with a history of any major psychiatric disorder or physical conditions such as unstable physical angina pectoris and pregnant females were excluded from the study.
Instruments
Threatening medical situation inventory (TMSI)
The TMSI was used to assess participants’ coping styles regarding information-seeking or avoidance. This validated instrument presents two hypothetical medical scenarios: One involving ambiguous symptoms (e.g., headaches, dizziness) and another related to the decision to undergo potentially risky heart surgery. Each scenario is followed by six coping statements (three blunting and three monitoring items), rated on a five-point Likert scale (1 = not at all applicable to 5 = strongly applicable). The coping style is determined by subtracting the blunter score from the monitor score.[10]
ISQ
The ISQ measures satisfaction with information received about illness and treatment. Participants categorize themselves into one of three groups: (a) Desire for all available information and involvement in decisions, (b) preference for only positive information, or (c) preference for limited information and for the doctor to make decisions. The ISQ comprises six statements rated on a five-point Likert scale.[11]
HRQoL scale-14 (HRQoL-14)
The HRQoL-14, developed by the Centers for Disease Control and Prevention, consists of 14 items assessing overall health and well-being. It includes three modules: Core healthy days, activity limitations, and healthy day symptoms.[12]
Depression, anxiety, and stress scale-21 (DASS-21)
The DASS-21 is a self-report instrument measuring depression, anxiety, and stress. It contains 21 items divided into three subscales, each ranging from 0 to 21. Scores for each subscale are obtained by multiplying the raw score by two.[13]
Statistical analysis
Descriptive statistics were used to summarize demographic data. The Fisher exact test assessed differences between proportions of categorical variables. Independent-sample t-tests were conducted to compare means between two groups. Pearson correlation and linear regression analyses were performed to examine relationships between variables. P < 0.05 was considered statistically significant.
RESULTS
The mean age of the participants was 57 years, with the lowest age being 40 years and the highest age being 65 years. 27.5% of the data belonged to lower socioeconomic status, 50% of the data belonged to middle socioeconomic status, and 22.5% of the data belonged to upper socioeconomic status. The mean duration of illness of the data was 5.4 years.
Table 1 shows an independent sample t-test which indicates difference between males and females and blunting and coping monitoring style for depression, anxiety stress, quality of life, and information satisfaction. The analyses indicate a statistically significant difference for depression and anxiety (t = 1.793, P = 0.040; t = 2.204, P = 0.016) between males and females. Patients with monitoring coping style had significantly higher DASS scores, poorer quality of life, and low information satisfaction than participants with blunting coping style (P < 0.001).
| Variable | Mean | Standard deviation | t | P-value | Mean | Standard deviation | t | P-value | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| M | F | M | F | Bl | Mo | Bl | Mo | |||||
| (D) | 8.3 | 11.1 | 5.120 | 4.745 | 1.793 | 0.040* | 6.631 | 12.476 | 4.474 | 3.893 | −4.417 | 0.000* |
| (A) | 06 | 8.7 | 4.255 | 3.450 | 2.204 | 0.016* | 4.842 | 9.619 | 3.484 | 3.138 | −4.562 | 0.000* |
| (S) | 11.6 | 13.3 | 6.508 | 5.992 | 0.859 | 0.197 | 8.736 | 15.809 | 5.625 | 4.728 | −4.381 | 0.000* |
| QoL | 13.3 | 12.1 | 9.148 | 7.383 | −0.456 | 0.325 | 8.631 | 16.381 | 7.274 | 7.378 | −3.339 | 0.000* |
| IS | 3.45 | 3.75 | 0.759 | 0.444 | 1.525 | 0.067 | 4 | 3.238 | 0 | 0.700 | 4.736 | 0.000* |
M: Male, F: Female; Bl: Blunters, Mo: Monitors, D: Depression, A: Anxiety, S: Stress, QoL: Quality of life, IS: Information satisfaction, *P-Value significant at 0.05 level
Table 2 shows correlational analyses between duration of illness, depression, anxiety, stress, quality of life, and information satisfaction for males. The results indicate a statistically significant positive association between depression and quality of life (r = 0.589; P = 0.006). A significant negative association was found between depression and information satisfaction (r = −0.578; P = 0.008), indicating lower information satisfaction with more severe of depression. Moderate negative correlation was found between information satisfaction and stress (r = −0.537; P = 0.015), and information satisfaction and quality of life (r = −0.551; P = 0.012).
| Variable | Duration of illness | (D) | (A) | (S) | QoL | Information satisfaction (IS) |
|---|---|---|---|---|---|---|
| Duration of illness | ||||||
| Pearson correlation | 1 | −0.156 | −0.245 | −0.343 | −0.248 | 0.436 |
| Sig. (two-tailed) | 0.511 | 0.298 | 0.138 | 0.293 | 0.054 | |
| (D) | ||||||
| Pearson correlation | −0.156 | 1 | 0.763** | 0.901** | 0.589** | −0.578** |
| Sig. (two-tailed) | −511 | 0.000 | 0.000 | 0.006 | 0.008 | |
| (A) | ||||||
| Pearson correlation | −0.245 | 0.763** | 1 | 0.806** | 0.427 | −0.358 |
| Sig. (two-tailed) | 0.298 | 0.000 | 0.000 | 0.060 | 0.121 | |
| (S) | ||||||
| Pearson correlation | −0.343 | 0.901** | 0.806** | 1 | 0.699** | −0.537* |
| Sig. (two-tailed) | 0.138 | 0.000 | 0.000 | 0.001 | 0.015 | |
| QoL | ||||||
| Pearson correlation | −0.248 | 0.589** | 0.427 | 0.699** | 1 | −0.551* |
| Sig. (two-tailed) | 0.293 | 0.006 | 0.060 | 0.001 | 0.012 | |
| Information satisfaction (IS) | ||||||
| Pearson correlation | 0.436 | −0.578** | −0.358 | −0.537* | −0.551* | 1 |
| Sig. (two-tailed) | 0.054 | 0.008 | 0.121 | 0.015 | 0.012 |
Table 3 shows correlational analyses of duration of illness, depression, anxiety, stress, quality of life, and information satisfaction for females. Quality of life and information satisfaction appear less directly linked to psychological distress in females. This suggests potential gender differences in how CAD patients experience and report the relationship between psychological well-being and functional outcomes.
| Variable | Duration of illness | Depression | Anxiety | Stress | QoL | Information satisfaction (IS) |
|---|---|---|---|---|---|---|
| Duration of illness | ||||||
| Pearson correlation | 1 | 0.273 | −0.158 | 0.255 | −0.206 | 0.361 |
| Sig. (two-tailed) | 0.244 | 0.506 | 0.279 | 0.384 | 0.118 | |
| (D) | ||||||
| Pearson correlation | 0.273 | 1 | 0.555* | 0.762** | 0.213 | −0.112 |
| Sig. (two-tailed) | 0.244 | 0.011 | 0.000 | 0.367 | 0.637 | |
| (A) | ||||||
| Pearson correlation | −0.158 | 0.555* | 1 | 0.646** | 0.344 | −0.429 |
| Sig. (two-tailed) | 0.506 | 0.011 | 0.002 | 0.137 | 0.059 | |
| (S) | ||||||
| Pearson correlation | 0.255 | 0.762** | 0.646** | 1 | 0.404 | −0.069 |
| Sig. (two-tailed) | 0.279 | 0.000 | 0.002 | 0.077 | 0.772 | |
| QoL | ||||||
| Pearson correlation | −.206 | 0.213 | 0.344 | 0.404 | 1 | −0.329 |
| Sig. (two-tailed) | 0.384 | 0.367 | 0.137 | 0.077 | 0.157 | |
| Information satisfaction (IS) | ||||||
| Pearson correlation | 0.361 | −0.112 | −0.429 | −0.069 | −0.329 | 1 |
| Sig. (two-tailed) | 0.118 | 0.637 | 0.059 | 0.772 | 0.157 |
Figure 1 shows the linear regression of age with DASS scores. A negative regression slope (R2 score: 0.0723) was observed, which explains 7.23% variance in psychological distress (DASS Scores) due to age. This finding indicates that older patients show slightly lower psychological distress.
- Regression analyses of age with depression, anxiety, and stress scale scores. (DASS: Depression, Anxiety, Stress Scale).
DISCUSSION
This study explored gender differences in cognitive coping styles and their impact on information satisfaction, HRQoL, and psychological distress among patients with CAD. Consistent with previous research, a significant proportion of CAD patients experience anxiety and depression, with prevalence rates reaching up to one-third of this population.[14]
Psychological distress
Our findings indicated that female participants exhibited higher median levels of psychological distress compared to males, aligning with existing literature that attributes this disparity to hormonal, genetic, and psychosocial factors such as family conflicts, multiple roles, gender discrimination, and variations in perceived social support.[15,16] Age-stratified analysis revealed that participants aged 40–55 years, irrespective of gender, reported higher levels of stress, depression, and anxiety, highlighting the unique challenges faced by younger and middle-aged adults with CAD.[17]
Higher educational attainment (above 10th grade) was associated with increased psychological distress, possibly due to heightened expectations for recovery and greater awareness of disease implications.[9] Furthermore, individuals with a shorter duration of illness (<6 years) reported elevated distress, likely reflecting the initial adjustment period to a chronic diagnosis and associated uncertainties.[4]
HRQoL
While prior studies have found poorer HRQoL among female cardiac patients,[18] our results showed that males had a higher median number of unhealthy days, suggesting a lower quality of life. This may be related to financial concerns, job security, and role transitions more commonly experienced by men.[19] Both younger age (40–55 years) and shorter illness duration were linked to poorer HRQoL. The lack of experience in managing the disease, limitations in physical activity, frequent medical appointments, and treatments may disrupt normal life routines, adding to the overall burden of the disease.[20]
Furthermore, higher education levels had a higher median for unhealthy days than patients with education up to the primary level. One reason could be that highly educated patients may have higher expectations for their recovery and treatment outcomes, which can result in disappointment and dissatisfaction. Concurrently, their busy professional lives might limit their ability to engage in lifestyle changes necessary for better health.
Cognitive coping styles
Both genders utilized monitoring (information-seeking) and blunting (information-avoidance) coping styles, but females were more likely to adopt a monitoring approach. This may be influenced by societal norms that encourage women to be more communicative and seek social support, while men often prioritize self-reliance and problem-solving.[21,22]
Younger participants also tended to use monitoring strategies, which can enhance engagement with treatment but may lead to information overload, increased distress, and inability to adhere to treatment protocols if not managed appropriately.[9] A study done on patients of colorectal cancer reported similar findings wherein females with higher education levels and younger age had higher monitoring scores.[23]
Information satisfaction
Most participants expressed overall satisfaction with the information provided about their illness. However, higher anxiety was associated with decreased information satisfaction, suggesting that anxious patients may have difficulty accepting or integrating medical information, which can impact their overall well-being.[24] Studies in oncology populations also support a bidirectional relationship between information satisfaction and psychological symptoms.[25]
Correlations among variables
A significant association was observed between coping style and psychological distress. Individuals with a monitoring style reported higher levels of depression, anxiety, and stress, consistent with previous findings in both cardiac and cancer populations.[9] Monitors often have a greater need for information but may experience lower satisfaction with the information received, potentially exacerbating distress. Tailoring information delivery to individual coping styles could help mitigate these effects.
Younger age was associated with lower HRQoL and information satisfaction, possibly due to challenges in accepting a chronic diagnosis and less experience navigating healthcare systems. Shorter illness duration was similarly linked to lower information satisfaction. Higher scores on depression, anxiety, and stress correlated with an increased number of unhealthy days, underscoring the interconnectedness of psychological distress and quality of life in CAD patients.
This study addresses a critical gap in understanding gender-specific experiences and coping strategies in CAD management. By examining a broad range of outcomes, including information-seeking behavior, satisfaction, and HRQoL, the study provides a holistic perspective on patient well-being. However, limitations include the cross-sectional design, which precludes assessment of long-term effects, and a small sample size, which may limit generalizability. Furthermore, this study did not account for menopausal status or related hormonal changes in female participants, which is a notable limitation given the well-established impact of menopause on cardiovascular risk and psychological health. Future research should incorporate menopausal status and hormone replacement therapy to better understand their roles with these variables.
CONCLUSION
This study provides actionable insights for clinicians, researchers, and policymakers aiming to improve the psychological and physical well-being of CAD patients through individualized, gender-sensitive, and psychologically informed care. Recognizing gender-based coping patterns can inform tailored interventions. For men: Foster supportive environments for discussing emotional challenges and address stress and anxiety directly. For women: Provide resources to manage ongoing stress and depression and leverage social support networks. For all patients: Promote HRQoL by addressing both emotional and physical aspects of recovery. A patient-centered approach that considers gender, age, education, and coping style may lead to more effective and holistic care for individuals with CAD.
Ethical approval:
The research/study was approved by the Institutional Review Board at the Institutional Ethics Committee, number DMCH/IEC/2024/332, dated 30/5/2024.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: This study was financially supported by the Prajwalika Scholarship Scheme (PSS).
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