Classification of illness attributions in patients with coronary artery disease

Abstract

Objective To examine patient-reported causal attributions in patients with coronary artery disease and classify them according to attribution theory. Design Patients with angiographically verified coronary artery disease (n = 459) were asked to report causal attributions by answering the respective open-ended item of the Brief Illness Perception Questionnaire. Main Outcome Measures Groups resulting from classifications were characterised with regard to sociodemographic and clinical variables, Quality of Life (SF-12), depression (PHQ-9), anxiety (GAD-7), and illness perception (BIPQ). Results Stress emerged as the single most important attribution followed by various behavioural factors and genetic predisposition. There was a remarkable mismatch between the presence of modifiable risk factors (smoking, obesity) and patient-reported illness attributions. Based on the results of the descriptive categorisation of illness attributions we developed a transparent, easily reproducible scheme for dimensional classification of the fifteen most common responses according to attribution theory. The classification resulted in four groups: Behaviour/Emotional State, Past Behaviour/Emotional State, Physical/Psychological Trait and External. Conclusion We found a pattern of illness attributions largely in line with previous trials. The dimensional classification resulted in four groups and highlighted potential entry points for physician-patient communication aimed at establishing beneficial disease self-management.