Self-efficacy – A Link between Mental Health and Cardiovascular Health in Cardiovascular Disease Patients: A Cross-sectional Study from Western India

Abstract Background: Cardiovascular disease (CVD) is often accompanied by depression and anxiety, which have a negative impact on the outcome of the disease. Self-efficacy, a psychological construct related to coping and health behaviors, may play an important role in the cardiovascular and mental health of these patients. Aim: The aim of this study was to investigate the association of self-efficacy with depression, anxiety, and cardiovascular health in patients with CVD and to assess the role of self-efficacy as a mediator. Materials and Methods: This cross-sectional study in a hospital involved 500 adult patients with diagnosed CVD recruited from a tertiary care center in India. Depression and anxiety were assessed by the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Self-efficacy was measured using the General Self-Efficacy Scale. Cardiovascular health was assessed on the basis of a composite Life’s Simple 7 (LS 7) scores. The associations were investigated by nonparametric tests and multivariate regression analysis. A mediation analysis was performed using 5000 bootstrap replicates. Results: Moderate-to-severe depressive symptoms were present in 225 participants (45.0%), while moderate-to-severe anxiety symptoms were observed in 195 participants (39.0%). In 209 participants, poor cardiovascular health was observed (41.8%). Depression (ρ = −0.42, P < 0.001) and anxiety (ρ = −0.38, P < 0.001) were negatively correlated with LS7 scores, whereas self-efficacy was positively correlated (ρ =0.46, P < 0.001). In a multivariate analysis, depression (β = −0.29, P < 0.001) and anxiety (β = −0.18, P < 0.003) independently predicted poorer cardiovascular outcomes, whereas self-efficacy was protective (β = 0.34, P < 0.001). A mediation analysis showed a significant indirect effect of depression on cardiovascular health through self-efficacy. Conclusion: Depression and anxiety are common in patients with CVD and are associated with poor cardiovascular function. Self-efficacy seems to attenuate this relationship and is a potential therapeutic goal. Integration of mental health assessments and self-efficacy-enhancing interventions into cardiovascular care can improve the results.