Emotion regulation and illness perceptions in African American women with heart failure

EMOTION REGULATION AND ILLNESS PERCEPTIONS IN AFRICAN AMERICAN WOMEN WITH HEART FAILURE By Kelly L. Wierenga African American women with heart failure (HF) are recognized to have compounded stressors that augment the strain of disease self-management and heighten the occurrence of negative health events. Emotion regulation, the experiencing, processing, and modulating of emotional responses, is required to facilitate adherence to HF self-management in the face of stressors. Research has identified relationships between emotional and physical health in African American women, but less is known about how illness perceptions and emotion regulatory capacity affect adherence and unanticipated negative health events. Thus, this prospective observational study examined emotion regulation, illness perceptions, and adherence to medications, exercise, and diet in African American women with HF. An integration of the common sense model of illness and process model of emotion regulation guided the project. Aims: The study examined the: 1) associations between psychological factors and emotion regulation, 2) relationships of contributing factors and illness perceptions with emotion regulation, and 3) effects of illness perceptions and emotion regulation on adherence and negative health events. Instruments: Socio-demographic, health, and medical record data, Perceived Stress, Hospital Anxiety and Depression, Attention Function Index, Illness Perception Questionnaire–Revised, Difficulties in Emotion Regulation (DERS), and Medical Outcomes Adherence Scales were included. Methods: A descriptive correlational design was used. Data analysis involved descriptives, regression, and path models. Procedure: Patients completed intake and follow-up interviews 30 days later. Medical records were reviewed 90 days post-recruitment. Results: 54 African American women with HF ages 49 to 84 years participated. Aim 1 findings demonstrated significant relationships among age, education, income, clinical severity, and stress. Age (β=-.03) and stress (β=.06) predicted increased difficulties with emotion regulation. Aim 2 findings showed relationships between younger age and increased DERS scores (β=.02). In Aim 3, the only significant relationship discovered was between New York Heart Association functional classification and negative health events. No associations were revealed between predictors and adherence behaviors. Limitations: Limited follow-up time, small sample size, and measurement issues impacted generalizability of the study’s findings. Implications: It is essential that care providers consider individualized illness perceptions and emotion regulatory processes when determining how to best support patients’ self-management. Current information for practitioners to support African American women with HF is limited. Findings demonstrated that African American women in this sample experienced high numbers of negative health events. It is necessary to understand how cognitive and emotional perceptions impact health outcomes in vulnerable populations such as African American women with HF. Further, research examining larger samples is warranted to better understand interactions between illness perceptions and emotion regulation in the presence of chronic illness in this population. Copyright by KELLY L. WIERENGA 2016