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Cognitive-Personality Style as Vulnerability to Depression in Patients With Coronary Artery Disease: Roles of Sociotropy and Autonomy

From the Department of Psychology, School of Behavioural Science, (L.S., H.J.J.) University of Melbourne, Australia; Centre for Women’s Mental Health, (L.S.) Royal Women’s Hospital, Parkville, Australia; Department of Psychiatry, (L.S.) University of Melbourne, Australia; ORYGEN Youth Health (H.J.J., M.B.) Parkville, Australia; Department of Clinical and Biomedical Sciences, (M.B.) Barwon Health and The Geelong Clinic, University of Melbourne Australia; and the Mental Health Research Institute, (M.B.) Parkville, Australia.

Address correspondence and reprint requests to Lesley Stafford, Centre for Women’s Mental Health, Royal Women’s Hospital, Locked Bag 300, Cnr Grattan Street and Flemington Rd, Parkville, VIC 3052. E-mail: Lesley.stafford{at}thewomen.org.au

Objective: To investigate whether the cognitive-personality styles of sociotropy and autonomy and their component subscales are useful for explaining depressogenic vulnerability in a population of individuals with coronary artery disease (CAD) and to better understand the psychosocial etiology of depression in CAD. Depression occurs commonly in patients with CAD and is associated with substantial disability.

Method: A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report at 3 (Time 1, T1) and 9 (Time 2, T2) months post discharge. The association between cognitive-personality styles and depression was tested in hierarchical linear regression equations controlling for clinical and demographic confounders.

Results: High levels of autonomy were significantly associated with increased depressive symptomatology at T1 (p < .001) and T2 (p < .001). The association between autonomy and change in depression approached significance (p = .07). Sociotropy was not a significant predictor of depression at any time. The component subscales of the sociotropy and autonomy measures explained more variance in depressive symptomatology at T1 and T2 as well as change in depression than did the composite measures. The perfectionism subscale of autonomy was the most important predictor of depression at T1 and T2 contributing 5.3% and 5.1% of unique variance in depression, respectively. There was a trend for the association between perfectionism and change in depression (p = .06).

Conclusion: Cognitive-personality characteristics are an important predictor of depression in recently hospitalized patients with CAD. The findings suggest a clinical benefit in early detection of highly autonomous patients, particularly those who exhibit perfectionism, coupled with appropriate cognitive intervention and collaborative treatment planning.

Key Words: cognitive-personality style • coronary artery disease • depression

Abbreviations: CABG = coronary artery bypass graft surgery; CAD = coronary artery disease; HADS = Hospital Anxiety Depression Scale; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty.