Relationship between Different Psychological Coping Strategies and Anxiety and Depression Levels in Heart Attack Patients

Psychological coping strategies and anxiety and depression level


  • Kuanysh Syman Institute of Natural Sciences and Geography, Abai Kazakh National Pedagogical University, Almaty, Kazakhstan
  • Saad Majeed Al-Tamimi Consultant Internist and Cardiologist, College of Medical Technology, Al-Farahidi University, Iraq
  • Ahmed W. AL Rubaye Al-Manara College For Medical Sciences, Maysan, Iraq
  • Mazin Abdullateef Alzubaidi Department of Anesthesia, Al-Mustaqbal University College, Babylon, Iraq
  • Ahmed Ali Amir Department of Medical Laboratories Technology, Al-Nisour University College, Baghdad, Iraq
  • Shatha Jawad Mohammed National University of Science and Technology, Dhi Qar, Iraq


Anxiety, Depression, Heart attack, Coping strategies


Background: Heart attack, as a threatening event, affects patients' mental health, thus causing symptoms of anxiety and depression. The current research was conducted with the aim to evaluate the relationship between different psychological coping strategies, and anxiety and depression levels in heart attack patients.

Methods: The current research was a cross-sectional study. In 2021, 237 heart attack patients were referred to Ibn Al-Bitar Specialized Hospital for Cardiac Surgery, Al Budoor Hospital, and Saint Raphael (Al Rahibat) Hospital in Baghdad, Iraq. A simple random sampling method was used to select a statistical sample of 114 patients. The Pearson correlation coefficient method was utilized. The collected data were analyzed in SPSS software. The statistical findings were considered significant at the 0.05 level.

Results: There was a significant negative correlation between anxiety and self-reliant (r = -0.538; P < 0.01), optimistic (r = -0.483; P < 0.01), supporting (r = -0.467; P < 0.01), and confronting (r = -0.391; P < 0.05) coping strategies. In addition, there was a significant negative correlation between depression and self-reliant (r = -0.342; P < 0.01), confronting (r = -0.317; P < 0.01), supporting (r = -0.292; P < 0.01), and optimistic (r = -0.209; P < 0.05) coping strategies. Moreover, the results indicated a significant positive correlation between the fatalistic coping strategy and the anxiety (r = 0.429; P < 0.01) and depression (r = 0.214; P < 0.05) variables.

Conclusion: Coping strategies are one of the main methods of improving life expectancy and well-being, and are essential in positive disease adaptation and reducing anxiety and depression levels in heart attack patients


Al-Alwany, A. A. (2017). Dual and multiple av nodal pathways, what is the deference in typical atrioventricular nodal reentrant tachycardia. Medical Journal of Babylon, 14(2), 382-388.

Al-Alwany, A. (2021). Latrogenic atrial septal defect post radiofrequency ablation in patients with left atrial SVT: Predictors and outcomes. Revista Latinoamericana de Hipertensión, 16(3), 185-191.

Al Alwany, A. A. (2022a). Arrhythmia related to hypertensive left ventricular hypertrophy in Iraqi patients: frequency and outcome. J Med Life., 15(9), 1115-1118. doi:JMedLife-15-1115 [pii];10.25122/jml-2022-0214 [doi]. Retrieved from PM:36415521

Al Alwany, A. A. (2022b). Echocardiographic Assessment of the Aortic Stenosis Valve Area: Parameters and Outcome. Echocardiography, 3, 2D.

Al Alwany, A. A. (2022c). Effect and benefit of percutaneous coronary intervention in chronic total occlusion on ventricular repolarization: QT correction and dispersion. J Med Life., 15(8), 1025-1030. doi:JMedLife-15-1025 [pii];10.25122/jml-2022-0207 [doi]. Retrieved from PM:36188654

Albus, C., Herrmann-Lingen, C., Jensen, K., Hackbusch, M., Munch, N., Kuncewicz, C. et al. (2019). Additional effects of psychological interventions on subjective and objective outcomes compared with exercise-based cardiac rehabilitation alone in patients with cardiovascular disease: A systematic review and meta-analysis. Eur.J Prev Cardiol., 26(10), 1035-1049. doi:10.1177_2047487319832393 [pii];10.1177/2047487319832393 [doi]. Retrieved from PM:30857429

Beck, A. T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.

Beck, A. T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Biber, S., Andonian, C., Beckmann, J., Ewert, P., Freilinger, S., Nagdyman, N. et al. (2019). Current research status on the psychological situation of parents of children with congenital heart disease. Cardiovasc.Diagn.Ther, 9(Suppl 2), S369-S376. doi:cdt-09-S2-S369 [pii];10.21037/cdt.2019.07.07 [doi]. Retrieved from PM:31737543

Bucourt, E., Martaille, V., Goupille, P., Joncker-Vannier, I., Huttenberger, B., Reveillere, C. et al. (2021). A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjogren's Syndrome; Impact of the Disease on Quality of Life, Psychological Adjustment, and Use of Coping Strategies. Pain Med, 22(2), 372-381. doi:5618633 [pii];10.1093/pm/pnz255 [doi]. Retrieved from PM:31710690

Capobianco, L., Faija, C., Husain, Z., & Wells, A. (2020). Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PLoS.One., 15(9), e0238457. doi:PONE-D-20-00665 [pii];10.1371/journal.pone.0238457 [doi]. Retrieved from PM:32911486

Clarke, D. M., & Currie, K. C. (2009). Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust, 190(S7), S54-S60. doi:cla10974_fm [pii];10.5694/j.1326-5377.2009.tb02471.x [doi]. Retrieved from PM:19351294

Dusseldorp, E., van Eldren, T., Maes, S., Meulman, J., & Kraaij, V. (1999). A meta-analysis of psychoeduational programs for coronary heart disease patients. Health Psychol., 18(5),

-519. doi:10.1037//0278-6133.18.5.506 [doi]. Retrieved from PM:10519467

Ferris, P. A., Sinclair, C., & Kline, T. J. (2005). It takes two to tango: personal and organizational resilience as predictors of strain and cardiovascular disease risk in a work sample. J Occup Health Psychol., 10(3), 225-238. doi:2005-08222-004 [pii];10.1037/1076-8998.10.3.225 [doi]. Retrieved from PM:16060726

Garnefski, N., Van Den Kommer, T., Kraaij, V., Teerds, J., Legerstee, J., & Onstein, E. (2002). The relationship between cognitive emotion regulation strategies and emotional problems: Comparison between a clinical and a non-clinical sample. European Journal of Personality, 16, 403-420. doi:doi:10.1002/per.458.

Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W. et al. (2000). Team management of patients with heart failure: A statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation, 102(19), 2443-2456. doi:10.1161/01.cir.102.19.2443 [doi]. Retrieved from PM:11067802

Hallas, C. N., Wray, J., Andreou, P., & Banner, N. R. (2011). Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart Lung., 40(2), 111-121. doi:S0147-9563(09)00325-2 [pii];10.1016/j.hrtlng.2009.12.008 [doi]. Retrieved from PM:20561889

Jaarsma, T., Hill, L., Bayes-Genis, A., La Rocca, H. B., Castiello, T., Celutkiene, J. et al. (2021). Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur.J Heart Fail., 23(1), 157-174. doi:EJHF2008 [pii];10.1002/ejhf.2008 [doi]. Retrieved from PM:32945600

Jalowiec, A. (2003). The Jalowiec coping scale. In : Strickland OL, Dilorio C, editors. Measurement of nursing outcomes. Vol. 3: Self care and coping (pp. 71–87.). 2nd ed. New York, NY: Springer.

Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019). Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am.Coll.Cardiol., 73(14), 1827-1845. doi:S0735-1097(19)30513-3 [pii];10.1016/j.jacc.2019.01.041 [doi]. Retrieved from PM:30975301

Johansson, P., Westas, M., Andersson, G., Alehagen, U., Brostrom, A., Jaarsma, T. et al. (2019). An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial. JMIR.Ment Health, 6(10), e14648. doi:v6i10e14648 [pii];10.2196/14648 [doi]. Retrieved from PM:31584000

Kasparian, N. A., Kan, J. M., Sood, E., Wray, J., Pincus, H. A., & Newburger, J. W. (2019). Mental health care for parents of babies with congenital heart disease during intensive care unit admission: Systematic review and statement of best practice. Early.Hum.Dev, 139, 104837. doi:S0378-3782(19)30475-X [pii];10.1016/j.earlhumdev.2019.104837 [doi]. Retrieved from PM:31455569

Konstam, V., Moser, D. K., & De Jong, M. J. (2005). Depression and anxiety in heart failure. J Card.Fail., 11(6), 455-463. doi:S1071-9164(05)00110-7 [pii];10.1016/j.cardfail.2005.03.006 [doi]. Retrieved from PM:16105637

Li, X., Yang, S., Wang, Y., Yang, B., & Zhang, J. (2020). Effects of a transtheoretical model - based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: a randomized controlled trial. BMC Public Health, 20(1), 420. doi:10.1186/s12889-020-08568-x [pii];8568 [pii];10.1186/s12889-020-08568-x [doi]. Retrieved from PM:32228532

Li, Z., Liu, S., Wang, L., & Smith, L. (2019). Mind-Body Exercise for Anxiety and Depression in COPD Patients: A Systematic Review and Meta-Analysis. Int J Environ.Res Public Health, 17(1). doi:ijerph17010022 [pii];ijerph-17-00022 [pii];10.3390/ijerph17010022 [doi]. Retrieved from PM:31861418

Liang, L. X., Liu, Y., Shi, Y. J., Jiang, T. T., Zhang, H. R., Liu, B. H. et al. (2022). Family care and subjective well-being of coronary heart disease patients after percutaneous coronary intervention: Mediating effects of coping strategies. Int J Nurs.Sci, 9(1), 79-85. doi:S2352-0132(21)00095-8 [pii];10.1016/j.ijnss.2021.09.006 [doi]. Retrieved from PM:35079608

Lichtman, J. H., Bigger, J. T., Jr., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lesperance, F. et al. (2008). Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, 118(17), 1768-1775. doi:CIRCULATIONAHA.108.190769 [pii];10.1161/CIRCULATIONAHA.108.190769 [doi]. Retrieved from PM:18824640

Mariani, R., Renzi, A., Di, T. M., Trabucchi, G., Danskin, K., & Tambelli, R. (2020). The Impact of Coping Strategies and Perceived Family Support on Depressive and Anxious Symptomatology During the Coronavirus Pandemic (COVID-19) Lockdown. Front.Psychiatry, 11, 587724. doi:10.3389/fpsyt.2020.587724 [doi]. Retrieved from PM:33281647

Marino, B. S., Lipkin, P. H., Newburger, J. W., Peacock, G., Gerdes, M., Gaynor, J. W. et al. (2012). Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation, 126(9), 1143-1172. doi:CIR.0b013e318265ee8a [pii];10.1161/CIR.0b013e318265ee8a [doi]. Retrieved from PM:22851541

Martens, E. J., de Jonge, P., Na, B., Cohen, B. E., Lett, H., & Whooley, M. A. (2010). Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease:The Heart and Soul Study. Arch Gen.Psychiatry, 67(7), 750-758. doi:67/7/750 [pii];10.1001/archgenpsychiatry.2010.74 [doi]. Retrieved from PM:20603456

Mazaheri, M., Daghaghzadeh, H., Afshar, H., & Mohammadi, N. (2013). The Effectiveness of the Unified Protocol on Emotional Dysregulation and Cognitive Emotion Regulation Strategies in Patients with Psychosomatic Disorders. International Journal of Body, Mind and Culture, 1(1), 73-82. Retrieved from

Mohammadi, A., Zargar, F., Malekpour, V., Omidi, A., & Akbari, H. (2018). Comparison of Emotions and Difficulties in Emotion Regulation between Mild Traumatic Brain Injured and Healthy Participants. International Journal of Body, Mind and Culture, 5(1), 14-23.

O'Doherty, V., Carr, A., McGrann, A., O'Neill, J. O., Dinan, S., Graham, I. et al. (2015). A controlled evaluation of mindfulness-based cognitive therapy for patients with coronary heart disease and depression. Mindfulness, 6, 405-416. doi:doi:10.1007/s12671-013-0272-0.

Oliveri, S., Ferrari, F., Manfrinati, A., & Pravettoni, G. (2018). A Systematic Review of the Psychological Implications of Genetic Testing: A Comparative Analysis Among Cardiovascular, Neurodegenerative and Cancer Diseases. Front.Genet., 9, 624. doi:10.3389/fgene.2018.00624 [doi]. Retrieved from PM:30619456

Pogosova, N., Saner, H., Pedersen, S. S., Cupples, M. E., McGee, H., Hofer, S. et al. (2015). Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur.J Prev Cardiol., 22(10), 1290-1306. doi:2047487314543075 [pii];10.1177/2047487314543075 [doi]. Retrieved from PM:25059929

Reid, J., Ski, C. F., & Thompson, D. R. (2013). Psychological interventions for patients with coronary heart disease and their partners: a systematic review. PLoS.One., 8(9), e73459. doi:PONE-D-13-14344 [pii];10.1371/journal.pone.0073459 [doi]. Retrieved from PM:24039950

Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am.Coll.Cardiol., 48(8), 1527-1537. doi:S0735-1097(06)01905-X [pii];10.1016/j.jacc.2006.06.055 [doi]. Retrieved from PM:17045884

Scott-Sheldon, L. A. J., Gathright, E. C., Donahue, M. L., Balletto, B., Feulner, M. M., DeCosta, J. et al. (2020). Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis. Ann.Behav Med, 54(1), 67-73. doi:5511695 [pii];kaz020 [pii];10.1093/abm/kaz020 [doi]. Retrieved from PM:31167026

Shen, X., Zhu, X., Wu, Y., Zhou, Y., Yang, L., Wang, Y. et al. (2018). Effects of a psychological intervention programme on mental stress, coping style and immune function in percutaneous coronary intervention patients. PLoS.One., 13(1), e0187745. doi:PONE-D-15-55896 [pii];10.1371/journal.pone.0187745 [doi]. Retrieved from PM:29357358

Silverman, A. L., Herzog, A. A., & Silverman, D. I. (2019). Hearts and Minds: Stress, Anxiety, and Depression: Unsung Risk Factors for Cardiovascular Disease. Cardiol.Rev., 27(4), 202-207. doi:10.1097/CRD.0000000000000228 [doi]. Retrieved from PM:30130257

Smaardijk, V. R., Maas, A. H. E. M., Lodder, P., Kop, W. J., & Mommersteeg, P. M. C. (2020). Sex and gender-stratified risks of psychological factors for adverse clinical outcomes in patients with ischemic heart disease: A systematic review and meta-analysis. Int J Cardiol., 302, 21-29. doi:S0167-5273(19)33509-0 [pii];10.1016/j.ijcard.2019.12.014 [doi]. Retrieved from PM:31937453

Sohrabzadeh-Fard, A., Parvaz, Y., Bakhtyari, M., & Abasi, I. (2021). Intolerance of Uncertainty, Emotional Dysregulation, and Health Anxiety: The Moderating Role of Coronavirus-Related Stress. International Journal of Body, Mind and Culture, 8(4), 263-271. Retrieved from

Sonia, C. (2005). Problem-Oriented Anxiety and Consumer Behavior. ACR European Advances

Su, J. J., Yu, D. S. F., & Paguio, J. T. (2020). Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta ÇÉanalysis. Journal of Advanced Nursing, 76(3), 754-772. Retrieved from Wiley Online Library.

Tully, P. J., Cosh, S. M., & Baumeister, H. (2014). The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom.Res, 77(6), 439-448. doi:S0022-3999(14)00353-5 [pii];10.1016/j.jpsychores.2014.10.001 [doi]. Retrieved from PM:25455809

Ulusoy, M., Hisli Sahin, N., & Erkmen, H. (1998). Turkish Version of the Beck Anxiety Inventory: Psychometric Properties. Journal of Cognitive Psychotherapy:An International Quarterly, 12(2), 163.

Yohannes, A. M., Willgoss, T. G., Baldwin, R. C., & Connolly, M. J. (2010). Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr.Psychiatry, 25(12), 1209-1221. doi:10.1002/gps.2463 [doi]. Retrieved from PM:20033905




How to Cite

Syman, K. ., Al-Tamimi, S. M. ., AL Rubaye, A. W. ., Alzubaidi, M. A. ., Amir, A. A. ., & Mohammed, S. J. . (2023). Relationship between Different Psychological Coping Strategies and Anxiety and Depression Levels in Heart Attack Patients: Psychological coping strategies and anxiety and depression level. International Journal of Body, Mind and Culture, 10(Special Issue). Retrieved from



Quantitative Study(ies)

Most read articles by the same author(s)