Award Date

May 2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Reimund Serafica

Second Committee Member

Jennifer Kawi

Third Committee Member

Andrew Reyes

Fourth Committee Member

Stephen Benning

Number of Pages



Purpose: The primary objective of this study is to evaluate fear of recurrence as a mediator of illness perception and perceived stress. This research will determine how illness perceptions and fear of recurrence affect perceived stress in the acute myocardial infarction (AMI) population. Other aims will observe how demographics predict patients who may experience increased fear of recurrence and stress in the AMI population, how the variables of fear of recurrence change over time, and if fear of recurrence is still a significant mediator after controlling for depression and anxiety.Rational/ Conceptual Basis/ Background: Acute myocardial infarctions (AMIs) are often accompanied by psychological sequelae that may interfere with survivors' physical, cognitive, and emotional recovery. Post-myocardial infarction patients are taught to take proactive measures toward preventing future cardiac events, including decreasing overall stress. Theoretical models suggest that illness perception, fear of recurrence, and stress can all influence health outcomes. The relationships between these variables have little empirical data within the AMI population. Utilizing Leventhal's common-sense method of self-regulation, this study will identify how fear of recurrence (or progression) mediates illness perception and perceived stress. Methods: In this repeated measures, descriptive design, adult AMI (n=171) survivors at a Level 1 trauma center, identified from hospital admissions between November 2021 and December 2022, as well as AMI survivors from Facebook recruitment methods, will respond to self-reported surveys measuring illness perception (Brief Illness Perceptions Questionnaire [BIPQ] Appendix B), fear of recurrence (Fear of Progression Questionnaire [FoP-Q] Appendix C), and perceived stress (Perceived Stress Scale [PSS-10] Appendix D). Demographics will be collected from patient-reported variables of concurrent health conditions and modifiable risk factors such as diet, exercise, and smoking. This data was collected two times at baseline and six weeks follow-up to identify changes over time. Results: Fear of recurrence mediated the relationship between illness perceptions and perceived stress in acute myocardial infarction (AMI) survivors [F (2,168) =43.31, R²=0.34, p<0.001]. Predictors of fear of recurrence include alcohol intake. The paired t-tests comparing fear of recurrence were not significantly different at baseline (M=68.45, SD=21.72) and six weeks follow-up (M=69.43, SD=21.40); [t (159) =1.64, p=0.10]. After controlling depression and anxiety, fear of recurrence was still a significant mediator of illness perceptions and perceived stress [B = 0.09, SE = 0.05, t (166) = 2.03, p = 0.044]. Conclusion: These results suggest that fear of recurrence is a significant predictor of perceived stress in AMI survivors, meaning that practitioners should discuss the possibility of reoccurrence with survivors and assess fear of recurrence. The level of alcohol intake may indicate those who are negatively coping with the fear of recurrence after an AMI. Time since AMI is not a factor in fear of recurrence, but more research should be done to make this conclusion. Depression and anxiety are independent of the fear of recurrence and may not capture those who fear another AMI. Keywords: Acute myocardial infarction, perceptions of illness, fear of recurrence, perceived stress, fear of progression


acute myocardial infarction; fear of progression; fear of recurrence; illness perception; leventhal; perceived stress


Health and Medical Administration | Nursing | Psychology

Degree Grantor

University of Nevada, Las Vegas




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