The Cardiac Self-Blame Attributions Scale as a Predictor of Physical and Mental Health Outcomes in Underrepresented Patients with Cardiovascular Disease
Abstract
Following a cardiovascular event, most patients engage in a causal search to
understand why it occurred. One way of distinguishing attributions is through the construct
of self-blame. There is a difference between patients blaming their illnesses on their own
behaviors, referred to as behavioral self-blame (BSB), and the tendency to attribute their
conditions to their dispositions, classified as characterological self-blame (CSB). BSB is
predicted to result in positive outcomes, whereas CSB is predicted to result in negative
outcomes. However, self-blame attributions have been associated with both positive and
negative health outcomes in patients with cardiovascular disease (CVD). One possible
reason for the discrepant findings is the lack of a validated, multiple-item measure of the
construct. Thus, the 11-item Cardiac Self-Blame Attributions (CSBA) scale was developed
to fill this gap. Preliminary analyses showed that this scale is a reliable and valid measure of
self-blame, but it was not known whether the CSBA scale is predictive of physical and
mental health outcomes. The purpose of this study was to examine if the CSBA scale is
associated with physical and mental health outcomes among underrepresented patients with
CVD before and after cardiac rehabilitation (CR). Health outcomes included depressive
symptoms, health-related quality of life (HRQoL), heart-healthy diet, and functional
capacity. A secondary aim was to assess whether the relationships between both types of
self-blame and health outcomes are mediated by control appraisals.
Self-reported, questionnaire data were collected from 95 patients at the beginning of
CR and after they completed CR (n = 50). Results confirmed the two-factor structure of the
CSBA scale, and indicated good internal validity and test-retest reliability. Both BSB and
CSB were significantly positively related to depressive symptoms and negatively related to
mental HRQoL cross-sectionally, but BSB was not related to any of the health outcomes
longitudinally. CSB was significantly negatively related to physical HRQoL at the end of
CR, but was not related to any other health outcomes longitudinally. Control appraisals at
the beginning of CR did not mediate the association between either type of self-blame and
health outcomes at the end of CR. Clinical and theoretical implications are discussed.
Table of Contents
Introduction -- Review of the literature -- Methodology -- Results -- Discussion -- Appendix A-1. Cardiac Self-Blame Attributions Scale, Times 1 & 2 -- Appendix A-2. Control Attitudes Scale-Revised, Times 1 & 2
Degree
Ph.D.