Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study

Abstract

BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness. OBJECTIVE: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI. MAIN MEASURES: Perceived global control, measured as two dimensions-Bconstraints^and Bmastery^-and health-specific control were self-reported. Event-free survival was measured in years, where Bevent^was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents' family. KEY RESULTS: Mean baseline age was 66.2 years; 994 (16.7 %) had DM and 3,023 (53.4 %) hypertension. Overall, 173 (3.1 %) suffered incident strokes, 129 (2.3 %) had incident MI, and 465 (8.2 %) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 % CI 1.07-1.67), hypertension (1.31, 95 % CI 1.07-1.61) and perceived constraints in the third (1.55, 95 % CI 1.12-2.15) and fourth quartiles (1.61, 95 % CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95 % CI 0.59-1.03) and fourth quartiles (HR 0.70, 95 % CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low healthspecific control had the highest risk (HR 1.93, 95 % CI 1.41-2.64).CONCLUSIONS: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

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“…Future research examining this question would be worthwhile. Regarding the self‐efficacy scale that was used in the present study, some authors have referred to it as a ‘locus of control scale’ (Dzivakwe, ) as well as a scale measuring ‘control beliefs’ (Duan‐Porter et al, ). However, the HRS documentation does report that ‘Sense of Control – Self‐Efficacy – Agency – Mastery.…”

At the Heart of Resilience: Empowering Women’s Agency in Navigating Cardiovascular Disease

“… 71 , 72 Research underscores the importance of exploring beliefs about control, in relation to the risk of mortality and major cardiovascular events. 73 , 74 Perceived control is a strong independent predictor of CVD mortality and may be considered a CVD risk factor. 75 Further investigation is required to ascertain its influence on patient engagement with healthcare systems and individual responses to clinical treatments.…”

“… 75 Further investigation is required to ascertain its influence on patient engagement with healthcare systems and individual responses to clinical treatments. 73 , 75 This need for a deeper understanding of the impact of beliefs about control on patient behaviour and treatment response becomes particularly pertinent in light of recent findings linking chronic medical conditions, such as CVD, with a significant rise in the likelihood of concurrent psychiatric disorders. A study of community respondents found that people suffering from 1 of 8 medical disorders, including CVD, had a 41% increase in the relative risk of having any recent psychiatric disorder, compared to people without chronic medical disorders.…”

Capsule Commentary on Duan-Porter et al., Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study

“…Duan-Porter and colleagues explored the relationship between control beliefs and health outcomes among US adults. 1 Among almost 6000 participants, those with greater belief in their control over their health were less likely to have strokes, heart attacks or die, while those with beliefs suggesting more constraints, who were more externally controlled, experienced higher rates. Patients with high control and low constraint beliefs did particularly well.…”