The role of psychiatric and psychosomatic correlates on lifestyles modification in cardiac rehabilitation.

Introduction: Cardiac rehabilitation (CR) is considered the most effective intervention for secondary prevention of patients with cardiovascular diseases. However, the role of psychiatric and psychosomatic complaints on the modification of unhealthy lifestyles is not clear. The aim of this research was to evaluate the impact of CR on risky lifestyles, considering the potential moderating role of depression, anxiety and psychosomatic syndromes on lifestyles modification. Methods: 108 patients undergone CR (experimental group) were compared with 85 people affected by cardiovascular diseases, not undergoing CR (control group). The assessment included: the Structured Clinical Interview for DSM-IV, the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), GOSPEL questionnaire on lifestyles, Pittsburgh Sleep Quality Index, and Morisky Medication Adherence Scale. Results: 32.1% and 19.2% of the sample suffered from depression and anxiety disorder, respectively. The most frequent DCPR syndromes were type A (31.9%), irritable mood (30.4%) and demoralization (29.3%). CR was associated with maintenance of physical activity, improvement of correct dietary behaviors and stress management, enhancement of quality of sleep. On the contrary, CR was not found to be associated with weight loss, healthy dietary habits, medications adherence. Depression and DCPR clusters of abnormal illness behavior, somatization and psychological factors affecting medical conditions mediated the modification of physical activity, stress management and pharmacological compliance. Discussion/conclusion: The findings underline the need of a psychosomatic assessment and an evaluation of psychological sub-clinical symptomatology in cardiac rehabilitation, in order to identify and address specific factors potentially associated with the clinical course of the heart disease.