The Role of Pain Self-Efficacy and Death Obsession in Predicting Defense Mechanisms: The Mediating Effect of Coping Strategies in Heart Failure Patients

Background and Objective: Patients with heart failure often endure significant psychological distress, including chronic pain, intrusive thoughts about mortality, and emotional dysregulation. Understanding the interplay between psychological constructs such as pain self-efficacy, death obsession, and defense mechanisms may inform more effective therapeutic strategies. This study aimed to examine the direct and indirect effects of pain self-efficacy and death obsession on defense mechanisms, with coping strategies serving as a mediating variable. Methods: A descriptive-correlational design was employed, and 310 patients with heart failure from Kish Island were selected through purposive sampling. Participants completed validated questionnaires measuring pain self-efficacy, death obsession, coping strategies, and defense mechanisms. Structural equation modeling (SEM) was used for data analysis. Results: Pain self-efficacy was negatively associated with maladaptive defense mechanisms (β = -0.20, p < 0.05), while death obsession showed a positive relationship (β = 0.26, p < 0.01). Coping strategies partially mediated both relationships, with significant indirect effects confirmed via the Sobel test. Model fit indices indicated satisfactory goodness-of-fit (CFI = 0.94, RMSEA = 0.05). Conclusion: Pain self-efficacy and death obsession significantly influence psychological defense mechanisms in heart failure patients, and coping strategies partially mediate these effects. These findings underscore the importance of psychosocial interventions that enhance adaptive coping and self-efficacy while addressing existential concerns in the context of cardiac care.