Development of a structural model of quality of life of heart patients based on the Center for Health Control and Disease Perception with the mediating role of mood dysphoria and cognitive flexibility

Document Type : Research Paper


1 PhD student General Psychology , Department of Psychology , Central Tehran Branch, , Islamic Azad University, Tehran , Iran.

2 Assistant Professor، Department of Psychology , Central Tehran Branch, Islamic Azad University, Tehran , Iran. (Corresponding author)

3 Assistant Professor، Department of Psychology , Central Tehran Branch, ,Islamic Azad University, Tehran , Iran.


The aim of this study was to develop a structural model of quality of life of heart patients based on the Center for Health Control and Disease Perception with the mediating role of mood dysphoria and cognitive flexibility.
Material and method
The method of this study was descriptive-correlation. The statistical population of the study included all heart patients referred to Shahid Rajaei Hospital, Tehran Heart Center and Khatam Al-Anbia Hospital in Tehran. A total of 281 patients were selected by convenience sampling and answered the Minnesota Quality of Life Questionnaire for Patients with Heart Failure, the Short Disease Perception Questionnaire, the Health Center Multidimensional Scale, the Cognitive Flexibility Questionnaire, and the Toronto Mood Dysfunction Scale.
Data analysis using structural equation modeling showed that the structural model of quality of life of heart patients based on health control and disease perception with the mediating role of mood dysphoria and cognitive flexibility fits. Also, there is a positive and significant relationship between health control center, disease perception and cognitive flexibility with quality of life (P <0.05), negative and significant relationship between mood distress and quality of life (P <0.05), between health control center and perception. Disease has a negative and significant relationship with quality of life (P <0.05) and there is a positive and significant relationship (P <0.05) between health control and disease perception with cognitive flexibility.
As a result, paying attention to the psychological dimensions and characteristics of patients with heart disease can bring a better understanding of this disease for patients and increase the quality of life.


  1. Nikpay, M., Goel, A., Won, H. H., Hall, L. M., Willenborg, C., Kanoni, S., ... & Farrall, M. (2015). A
    comprehensive 1000 Genomes–based genome-wide association meta-analysis of coronary artery
    disease. Nature genetics, 47(10), 1121.
    2. Sacks, F. M., Lichtenstein, A. H., Wu, J. H., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., ... & Van
    Horn, L. V. (2017). Dietary fats and cardiovascular disease: a presidential advisory from the American Heart
    Association. Circulation, 136(3), e1-e23.
    3. Okutucu, S. E. R. C. A. N., Sabanov, C., Karakulak, U. N., Evranos, B., Fatihoglu, S. G., Sahiner, L., ... &
    Oto, A. (2011). Validation of the Turkish Versionof the Minnesota Living with Heart Failure
    Questionare. International Journal of Cardiology, (147), 74-82.
    4. Bahador, Razieh Sadat; Noah, Infallibility; Jahani, Younes (1396). Quality of life and its related factors in
    patients with chronic heart failure referred to Imam Khomeini Hospital in Jiroft. Iranian Journal of Nursing. 30
    (105). 33-23.
    5. Schultz, Duane; Schultz, Sydney Allen (2015). Personality Theories: Perspectives and Theories, translated by
    Yahya Seyed Mohammadi (1398). Tehran: Ravan Publishing.
  2. 6. Rizza, F., Gison, A., Bonassi, S., Dall’Armi, V., Tonto, F., & Giaquinto, S. (2017). ‘Locus of control’, healthrelated quality of life, emotional distress and disability in Parkinson’s disease. Journal of health
    psychology, 22(7), 844-852.
    7. Helvik, A. S., Bjørkløf, G. H., Corazzini, K., Selbæk, G., Laks, J., Østbye, T., & Engedal, K. (2016). Are
    coping strategies and locus of control orientation associated with health-related quality of life in older adults
    with and without depression?. Archives of Gerontology and Geriatrics, 64, 130-137.
    8. Byrne, M., Walsh, J., & Murphy, A. W. (2005). Secondary prevention of coronary heart disease: patient beliefs
    and health-related behaviour. Journal of psychosomatic research, 58(5), 403-415.
    9. Mohajerani, Sepehr; Facts, Seyed Abbas; Adibi, Peyman (1396). The relationship between emotional malaise,
    disease perception and resilience with quality of life in patients with ulcerative colitis. Journal of
    Gastroenterology. 22 (1). 38-28.
    10. Zahraei, Shaghayegh; Amini, Shokoofeh; Saebi, Susan (1397). Relationship between disease perception,
    stigma experience and cognitive fusion with quality of life in women with multiple sclerosis. Psychological
    studies. 2 (14). 40-25.
    11. Vaske, I., Kenn, K., Keil, D. C., Rief, W., & Stenzel, N. M. (2017). Illness perceptions and coping with disease
    in chronic obstructive pulmonary disease: Effects on health-related quality of life. Journal of health
    psychology, 22(12), 1570-1581.
    12. Fanakidou, I., Zyga, S., Alikari, V., Tsironi, M., Stathoulis, J., & Theofilou, P. (2018). Mental health,
    loneliness, and illness perception outcomes in quality of life among young breast cancer patients after
    mastectomy: the role of breast reconstruction. Quality of Life Research, 27(2), 539-543.
    13. Mahdavi, Alnaz; Manshi, Gholamreza (1395). Comparison of mood dysphoria and emotional expression in
    patients with coronary heart disease and healthy individuals. Feyz Scientific-Research Bi-Monthly. 20 (3).
    14. Hobson, H., Hogeveen, J., Brewer, R., Catmur, C., Gordon, B., Krueger, F., ... & Grafman, J. (2018).
    Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired
    alexithymia. Neuropsychologia, 111, 229-240.
    15. Kafetsios, K., & Hess, U. (2019). Seeing mixed emotions: Alexithymia, emotion perception bias, and quality
    in dyadic interactions. Personality and Individual Differences, 137, 80-85.
    16. Tesio, V., Di Tella, M., Ghiggia, A., Romeo, A., Colonna, F., Fusaro, E., ... & Castelli, L. (2018). Alexithymia
    and depression affect quality of life in patients with chronic pain: a study on 205 patients with
    fibromyalgia. Frontiers in psychology, 9, 442.
    17. de Andrade Vieira, R. V., Vieira, D. C., Gomes, W. B., & Gauer, G. (2013). Alexithymia and its impact on
    quality of life in a group of Brazilian women with migraine without aura. The journal of headache and
    pain, 14(1), 1-10.
    18. Iglesias-Rey, M., Barreiro-de Acosta, M., Caamaño-Isorna, F., Vázquez Rodríguez, I., Lorenzo Gonzalez, A.,
    Bello-Paderne, X., & Domínguez-Muñoz, J. E. (2012). Influence of alexithymia on health-related quality of
    life in inflammatory bowel disease: are there any related factors?. Scandinavian journal of
    gastroenterology, 47(4), 445-453.
    19. Mohammadpour, Samaneh; Rahimian Booger, Ishaq; Rezaei, Ali Mohammad (1394). The role of defense
    styles and mood dysphoria in predicting the quality of life of coronary heart patients. Scientific-Research
    Journal of Zanjan University of Medical Sciences. 23 (97). 54-48.
    20. Sadeghpour, Maryam; Salehi Imran, Mohammad Taqi; Yaqubi, Abdul Ali (2015). Comparison of emotional
    malaise and quality of life between coronary heart patients and healthy individuals. International Conference
    on Humanities, Psychology and Social Sciences, University of Tehran, Ilia Capital of Ideas.
    21. Fikri, Akram; Isa Zadegan, Ali; Mikaeli Manieh, Farzaneh (1394). Comparison of cognitive emotion
    regulation strategies and emotional dysphoria in people with essential hypertension and non-patients.
    Contemporary Psychology. 10 (19). 94-85.
    22. Rezaei, Zahra; Fatah, Najma (1397). Predicting pain perception and perceived social support based on mood
    dysphoria in patients with chronic pain. National Conference on Psychology and Health with a focus on family
    and healthy living. Shiraz.
    23. Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and
    estimates of reliability and validity. Cognitive therapy and research, 34(3), 241-253.
    24. Phillips, E. L. (2011). Resilience, Mental Flexibility, and Cortisol Response to the Montral Imaging Stress
    Task in Unemployed Men (Doctoral dissertation).
  3. 25. Prado, V. F., Janickova, H., Al-Onaizi, M. A., & Prado, M. A. (2017). Cholinergic circuits in cognitive
    flexibility. Neuroscience, 345, 130-141.
    26. Yaqubi, Hamid; Brothers, Majid; Ranjbar Noshari, Farzaneh; Joki Chegini, Mahnaz (1394). A comparative
    study of irrational beliefs, social support and personality type A. Coronary heart disease and healthy
    individuals. New psychological research. 10 (37). 224-211.
    27. Kroemeke, A. (2019). Coping flexibility and health-related quality of life among older adults: the
    compensatory effect of co-rumination. Frontiers in psychology, 10, 59.
    28. Rudnik, A., Piotrowicz, G., Basińska, M. A., & Rashedi, V. (2019). The importance of cognitive flexibility
    and flexibility in coping with stress for the quality of life in inflammatory bowel disease patients during
    biological therapy. A preliminary report. Przeglad gastroenterologiczny, 14(2), 121.
    29. Aflak Sir, Abdul Aziz; Ryufi, Sarah (1391). Predicting psychosocial adaptation to disease based on the
    components of the Health Control Center in type II diabetic patients in Shiraz. Ministry of Science, Research
    and Technology - Shiraz University - Faculty of Psychology and Educational Sciences.
    30. Klein, Paul (2014). An easy guide to factor analysis. Translated by Seyed Jalal Sadr al-Sadat and Asghar
    Minaei (2015). Tehran: Samat Publications.
    31. Bennett, S. J., Oldridge, N. B., Eckert, G. J., Embree, J. L., Browning, S., Hou, N., ... & Murray, M. D. (2002).
    Discriminant properties of commonly used quality of life measures in heart failure. Quality of life
    research, 11(4), 349-359.
    32. Abbasi, Saturn; Mohammadi, Isa; Sadeghian, Hakimeh; Gholami Fesharaki, Mohammad (1395). Evaluation of
    quality of life in patients with heart failure. Nursing research. 11 (2). 32-10.
    33. Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception
    questionnaire. Journal of psychosomatic research, 60(6), 631-637.
    34. Arjmand, Mohsen; Qasemzadeh, Habibullah; Hamidpour, Hassan; Sharifi, Vandad; Mohseni far, star; Rajablu,
    Mansoura; Harirchi, Iraj (1389). Evaluation of breast cancer perception in patients, their families, healthy
    individuals and specialists (Abstract of the 10th Annual Conference of the Iranian Scientific Association of
    Psychiatrists). Iranian Journal of Psychiatry and Clinical Psychology (Thought and Behavior). 16 (62). 269-
    35. Kalantari, Hamid; Bagherian Sararoudi, Reza; Afshar, Hamid; Khormian, Newsha; Forouzandeh, Nasim;
    Daghaqzadeh, Hamed; Marathi, Mohammad Reza; Adibi, Peyman (1391). The relationship between disease
    perception and quality of life in patients with irritable bowel syndrome, Journal of Mazandaran University of
    Medical Sciences. 22 (90). 41-33.
    36. Wallston, K. A., Strudler Wallston, B., & DeVellis, R. (1978). Development of the multidimensional health
    locus of control (MHLC) scales. Health education monographs, 6(1), 160-170.
    37. Mani, Arash; Ahsanat, Negar; Palm tree, Newsha; Asadi Pouya, Ali Akbar (1397). Investigation of
    psychometric properties of Form C from the multidimensional scale of health control source on normal adults.
    Sadra Journal of Medical Sciences. 7 (1). 58-47.
    38. Soltani, Ismail; Shara, Hussein; Bahrainis, Seyed Abdul Majid; Farmani, Azam (1392). The mediating role of
    cognitive flexibility in the relationship between coping styles and resilience with depression, Bulletin of
    Research in Medical Sciences. 18 (2). 96-88.
    39. Kohandani, Mahdieh; Abu al-Ma'ali al-Husseini, Khadijeh (1396). Factor structure and psychometric
    properties of the Persian version of the Dennis, Vanderwall and Gillon Cognitive Flexibility Questionnaire.
    Psychological methods and models. 8 (29). 70-53.
    40. Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item
    selection and cross-validation of the factor structure. Journal of psychosomatic research, 38(1), 23-32.
    41. Besharat, Mohammad Ali (1390). Investigation of psychometric properties of short-form form of selfregulation in a sample of Iranian society. Clinical Psychology Research and Counseling. 1 (2). 70-53.
    42. Zakeri, Mohammad Mehdi; Hassani, Jafar; Ismaili, Nafiseh (1396). The Effectiveness of Teaching Emotional
    Process Regulation Strategies in Emotional Dysfunction in People with Psoriasis. Clinical Psychology. 9 (2).
    43. Spain, L. A., Tubridy, N., Kilpatrick, T. J., Adams, S. J., & Holmes, A. C. N. (2007). Illness perception and
    health‐ related quality of life in multiple sclerosis. Acta Neurologica Scandinavica, 116(5), 293-299.