The effects of self-efficacy, appraised threat, and depressive symptoms on social and physical functioning among older cardiac patients.

Abstract

Growing attention is being directed toward the impact of chronic illnesses on the lives of older adults. Heart disease, the leading cause of death, results in high rates of functional impairment and medical care costs. Preventing the progression of impairment to disability includes not only medical services but positive patient expectations about managing heart disease and the threat of harm or loss it represents. Older cardiac patients who underestimate abilities to control heart disease and to minimize its threat may excessively curtail activities beyond limits imposed by their disease status. The present study, a secondary data analysis, employed Social Cognitive and Stress, Appraisal, and Coping Theories to develop a causal model of relationships among self-efficacy to control cardiac symptoms, appraised threat, depression, and physical and social functioning. Study participants (N = 488), aged 60 to 93, were recruited from four outpatient facilities. Data were collected by telephone interview as part of a larger intervention study. The LISREL VI program was used to test the model separately with four functional outcomes: social interaction, home management, recreation, and ambulation. Self-efficacy was predicted to affect functioning indirectly through effects on threat and depression. Model fit criteria revealed good fit of the model to the data for one of the outcomes, the social interaction outcome. The model was modified to include a direct effect of threat on home management, ambulation, and recreation. Multigroup LISREL analysis established structural invariance by gender, and replication provided evidence of invariance across two random subsamples. Participants who perceived high self-efficacy and low threat had lower levels of depression. Depression had a stronger effect on social interaction than on the three physically-oriented outcomes, which were more strongly affected by level of threat. Educational interventions that enhance self-efficacy may affect functional outcomes not only through health behavior change but by reduction of appraised threat and depression.