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.

Keywords:

• Causal attributions
• attribution theory
• illness perception
• Brief Illness Perception Questionnaire

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Roesch and Weiner did not differentiate between behavioural attributions referring to the past and such attributions referring to the present. We think it is important to make this distinction because, with respect to controllability, references to past lifestyle are more similar to attributions referring to physical or psychological traits.