Academic journal article North American Journal of Psychology

Pessimistic Attributional Style and Cardiac Symptom Experiences: Self-Efficacy as a Mediator

Academic journal article North American Journal of Psychology

Pessimistic Attributional Style and Cardiac Symptom Experiences: Self-Efficacy as a Mediator

Article excerpt

Cardiovascular disease (CVD) is the leading cause of death in the United States (Roger et al., 2011). It is estimated that one American dies from CVD every 39 seconds, and that 33.6% of deaths in 2007 were attributable to CVD. Currently, the American Heart Association estimates that one in three Americans has at least one form of CVD. These prevalence data underscore the importance of secondary prevention programs, like cardiac rehabilitation (CR), for CVD patients. CR programs have been shown to markedly affect health outcomes, including reducing rates of all-cause mortality, cardiac-related mortality, and myocardial infarction, and improving functional status, quality of life appraisals, and modifiable risk factors such as cholesterol levels and blood pressure (Clark, Hartling, Vandermeer, & McAlister, 2005; Taylor et al., 2004). Over the past two decades, pessimistic attributional style has emerged as a psychosocial correlate of poor health, including CVD.

Attributional style is defined as the way in which people explain the causes of negative events involving themselves. It is comprised of three dimensions from which attributions about the causes of negative events are made: (a) internality, (b) stability, and (c) globality (Peterson, Buchanan, & Seligman, 1995). Internality is the degree to which an event is attributed to something about oneself, stability reflects the degree to which an event is a result of long-lasting causes, and globality refers to the pervasiveness of the cause of an event. People who characteristically explain the causes of negative events as internal, stable, and global are said to have a pessimistic attributional style; conversely, individuals who attribute the causes of negative events to external, unstable, and specific forces are said to exhibit an optimistic attributional style. Research has shown that male participants in a CVD prevention program with a pessimistic attributional style were more likely to die than their optimistic counterparts (Buchanan, 1995), and that the stable dimension had the strongest relationship with mortality of the three dimensions. In another study, the stable dimension interacted with socioeconomic status (SES) to affect blood pressure, a strong risk factor for CVD, among women (Grewen et al., 2000). That is, women who scored high on stability and were identified as being of low SES had significantly higher systolic blood pressures than women who scored high on stability but were of high SES, as well as women who scored low on stability, regardless of SES.

Adopting a pessimistic attributional style has been linked to other forms of poor health, including illness (Dykema, Bergbower, & Peterson, 1995), poor immune functioning (Kamen-Siegel, Rodin, Seligman, & Dwyer, 1991), poor metabolic control (Kuttner, Delamater, & Santiago, 1990), morbidity (Levy, Slade, & Ranasinghe, 2009; Peterson, Seligman, & Vaillant, 1988), and mortality (Peterson, Seligman, Yurko, Martin, & Friedman, 1998). Research also has demonstrated independent, negative effects of the stable and global dimensions on health status. For example, the stable dimension has been linked to self-reported disability among rheumatoid arthritis patients (Hommel et al., 2000) and poor self-reported health among CVD patients in CR (Bennett & Elliott, 2005). Research also has shown the global dimension to be a correlate of self-reported illness experiences (Bennett & Elliott, 2002; Chaney et al., 1996) and mortality (Peterson et al., 1998).

With the establishment of pessimistic attributional style as a correlate of poor health, researchers have examined the possible mechanisms underlying this relationship. Several mediators have been suggested (Peterson, 1995). First, it is possible that people with a pessimistic attributional style perceive or experience more stress in their lives, which, in turn negatively affects health (Dykema et al., 1995). …

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