Open Single Item of Perceived Risk Factors (OSIPRF) toward Cardiovascular Diseases Is an Appropriate Instrument for Evaluating Psychological Symptoms

Document Type : Brief Communications


1 Master of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran.

2 Master of Clinical Psychology, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.


Psychological symptoms are considered as one of the aspects and consequences of cardiovascular diseases (CVDs), management of which can precipitate and facilitate the process of recovery. Evaluation of the psychological symptoms can increase awareness of treatment team regarding patients’ mental health, which can be beneficial for designing treatment programs (1). However, time-consuming process of interviews and assessment by questionnaires lead to fatigue and lack of patient cooperation, which may be problematic for healthcare evaluators. Therefore, the use of brief and suitable alternatives is always recommended.
The use of practical and easy to implement instruments is constantly emphasized. A practical method for assessing patients' psychological status is examining causal beliefs and attitudes about the disease. The causal beliefs and perceived risk factors by patients, which are significantly related to the actual risk factors for CVDs (2), are not only related to psychological adjustment and mental health but also have an impact on patients’ compliance with treatment recommendations (3).
It seems that several risk factors are at play regarding the perceived risk factors for CVDs such as gender (4), age (5), and most importantly, patients’ psychological status (3). Accordingly, evaluation of causal beliefs and perceived risk factors by patients could probably be a shortcut method for evaluation of patients’ psychological health. In recent years, Saeidi and Komasi (5) proposed a question and investigated the perceived risk factors with an open single item: “What do you think is the main cause of your illness?”. According to the authors, the perceived risk factors are recorded in five categories including biological (age, gender, and family history), environmental (dust, smoke, passive smoking, toxic substances, and effects of war), physiological (diabetes, hypertension, hyperlipidemia, and obesity), behavioral (lack of exercise, nutrition, physical work stress, cigarette smoking, and sub‌stance abuse), and psychological factors (stress, anxiety, mourning and de‌pression, anger and rage, and spouse abuse) (5, 6). This instrument was designed in 2014 and has been employed in numerous studies (4).
The conducted studies using the open single item of perceived risk factors (OSIPRF) demonstrated that patients’ causal beliefs regarding CVDs could be a suitable instrument for screening for psychological symptoms, particularly anxiety and depression. In this regard, the results of a study showed that patients with a perceived risk factor experience higher levels of depression and anxiety compared with patients without a perceived risk factor (7). Furthermore, two studies revealed that patients with a physiological and/or psychological perceived risk factor experience higher levels of depression and anxiety compared with those with other classes of risk factors (6, 8). Therefore, management of their psychological status seems to be imperative.
Overall, it seems that application of the OSIPRF rather than time-consuming screening instruments is more affordable in terms of time, patient cooperation, diagnosis, and provision of timely services to those with adverse psychological status. Thus, given the knowledge of patients' regarding their psychological status and its management at disease onset may be beneficial in the process of physical recovery and returning to work, use of this diagnostic method by health professionals in the field of CVDs is recommended.


  1. Komasi S, Saeidi M, Montazeri N, Masoumi M, Soroush A, Ezzati P. Which factors unexpectedly increase depressive symptom severity in patients at the end of a cardiac rehabilitation program? Ann Rehabil Med. 2015; 39:872-9.
  2. Perkins-Porras L, Whitehead DL, Steptoe A. Patients' beliefs about the causes of heart disease: relationships with risk factors, sex and socio-economic status. Eur J Cardiovasc Prev Rehabil. 2006; 13:724-30.
  3. Saeidi M, Soroush A, Komasi S, Moemeni K, Heydarpour B. Attitudes toward cardiovascular disease risk factors among patients referred to a cardiac rehabilitation center: importance of psychological attitudes. Shiraz E Med J. 2015; 16:e22281.
  4. Saeidi M, Komasi S, Soroush A, Zakiei A, Shakeri J. Gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. J Cardio Thorac Med. 2014; 2:215-20.
  5. Komasi S, Saeidi M. Aging is an important cause for a lack of understanding of the main risk factor in cardiac rehabilitation patients. Thrita. 2015; 4:e32751.
  6. Komasi S, Saeidi M. Screening for depressive symptoms at the beginning of outpatient cardiac rehabilitation by assessed perceived risk factors by patients. Clin Med Rev Case Rep. 2015; 2:81.
  7. Komasi S, Saeidi M. A perceived risk factor may lead to increased anxiety and depression in cardiovascular patients. Jundishapur J Chron Dis Care. 2016; 5:e34159.
  8. Saeidi M, Komasi S, Heydarpour B, Momeni K, Zakiei A. Those who perceive their disease as a physiological or psychological risk factor experience more anxiety at the beginning of cardiac rehabilitation program. Res Cardiovasc Med. 2016; 5:e29291.