Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Diann E. Gaalema

Second Advisor

Sherrie Khadanga


Background:Psychological difficulties are common surrounding cardiac events and may remain elevated for some time during patient recovery. Evidence suggests that depression, anxiety, and kinesiophobia, or the fear of body movement, may negatively impact patients’ recovery. A comprehensive grasp of these factors and their progression in cardiac patients is currently lacking, despite their significant health implications. Methods: Patients hospitalized for an acute cardiac event were eligible for the study. Participants completed a demographic and psychological questionnaire in hospital. The psychological battery included the 8 item Patient Health Questionnaire-8, the 7 item General Anxiety Disorder-7, and the 17 item Tampa Scale for Kinesiophobia Heart. The battery was repeated at 1- and 3-months post-discharge. Associations of demographic and clinical characteristics with psychological outcomes were analyzed using correlations and t-tests. Changes in psychological symptoms over time were analyzed using repeated measures analysis of variance. Results: A sample of 80 participants were recruited in-hospital with 51 completing follow-up at 1-month, and 23 participants at 3-month. Most participants were male (69%) and rural (85.2%). Our sample was majority white (96%) and more than half (55%) had undergone a surgical procedure. The prevalences of all three psychological factors were high with 27.5% of participants having moderate/severe depression symptoms, 28.7% of patients exhibiting moderate/severe symptoms of anxiety, and 50% of participants with levels of kinesiophobia above the recommended cutoff of 37+ points. At time of hospitalization, higher depression symptoms were correlated with being female, having surgery, having Medicaid insurance, and being unmarried. Higher anxiety was correlated with younger age, being female, and having a surgical diagnosis. Higher levels of kinesiophobia were correlated with having Medicaid insurance. We found no evidence that depression or kinesiophobia changed over time. However, we detected a significant decrease in anxiety symptoms from hospitalization to 1-month into recovery. Discussion: This study provides a detailed report of depression, anxiety, and kinesiophobia in cardiovascular disease patients. A significant proportion of participants in our sample reported concerning levels of all three psychological symptoms. We did not detect a significant decrease in kinesiophobia or depression symptoms over time, but anxiety symptoms dropped by 1-month. These outcomes highlight not only that kinesiophobia is distinct from generalized anxiety but also that it is present at higher levels and is more persistent during recovery following a cardiac event. Given the detrimental effects of inactivity post-event, kinesiophobia requires additional scrutiny in this population.



Number of Pages

68 p.

Included in

Psychology Commons