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.