Italian Adaptation and Psychometric Validation of the Cardiac Distress Inventory in Patients with Recent Cardiac Events

Background: Acute cardiac events trigger multifaceted psychological responses captured by the construct of cardiac distress, a persistent negative emotional state involving multiple psychosocial domains. The Cardiac Distress Inventory (CDI) assesses this construct, but no Italian version exists. This study aimed to translate the CDI and assess its psychometric properties. Methods: After translation and back-translation, face validity was assessed with five patients and content validity with healthcare professionals. The CDI was administered to 293 patients who experienced a recent cardiac event from two Italian centers. Missing data were handled with multiple imputations. Exploratory factor analysis (EFA; principal axis factoring, oblimin rotation) assessed factorial structure. Criterion validity was assessed using correlations with Emotion Thermometers, Patient Health Questionnaire-4 (PHQ-4) and Kessler-6 (K6); ROC analysis assessed discriminative accuracy and the optimal cut-off. Results: The questionnaire demonstrated good face validity and suboptimal content validity (CVI-S/Ave = 0.72). EFA revealed a five-factor structure explaining 54% of the variance: “Role Change and Adaptation to Disease”, “Emotional Overwhelm, “Cognitive Challenges”, “Social Disconnection”, and “Health System Challenges”. The final 46-item version showed good internal consistency (ω = 0.857–0.926) and discriminative accuracy (AUC = 0.84), with an optimal cut-off of 36 (sensitivity 71%, specificity 84%). Conclusions: The current study provides preliminary evidence for the validity of the Italian CDI. Additional studies are needed to confirm the proposed structures and clinical cut-offs.