{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:32:21Z","timestamp":1790026341605,"version":"4.0.1"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T00:00:00Z","timestamp":1511481600000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["iaap-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Applied Psych Health &amp;amp; Well"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The literature has outlined positive effects of cardiac rehabilitation (\n                      <jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>\n                      ) on clinical psychological distress (\n                      <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\n                      depression and anxiety) and quality of life (QoL). In cardiac settings, subclinical distress (subthreshold depressive and anxious symptomatology) and psychological well\u2010being also showed relevant clinical implications. This research explored these psychological variables, their changes over time and cardiac course of\n                      <jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>\n                      patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Clinical and subclinical distress, QoL, and psychological well\u2010being were assessed in 108 consecutive patients undergoing\n                      <jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>\n                      , at baseline and up to 12\u00a0months after the program's completion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of all patients, 25.9 per cent showed high distress with a\n                      <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\n                      diagnosis, 31.5 per cent high distress without a\n                      <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\n                      diagnosis, and 42.6 per cent low distress. Comparing these subgroups, worse QoL and psychological well\u2010being were significantly linked not only to clinical but also to subclinical distress. After\n                      <jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>\n                      completion, a significant reduction in\n                      <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\n                      diagnoses was observed, whereas there were no positive effects on subclinical distress, QoL, and well\u2010being, or when they initially occurred, they were not long lasting. Moreover, only the subgroup with high distress without a\n                      <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\n                      diagnosis was at greater risk for adverse cardiac outcomes, showing worse scores on items of contentment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      These findings confirm data on clinical distress reduction after\n                      <jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>\n                      completion. However, a large amount of relevant subclinical distress remains and predicts adverse cardiac events.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aphw.12098","type":"journal-article","created":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T05:53:16Z","timestamp":1512107596000},"page":"349-369","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical and Subclinical Distress, Quality of Life, and Psychological Well\u2010Being after Cardiac Rehabilitation"],"prefix":"10.1111","volume":"9","author":[{"given":"Sara","family":"Gostoli","sequence":"first","affiliation":[{"name":"University of Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzo","family":"Roncuzzi","sequence":"additional","affiliation":[{"name":"Bellaria Hospital Bologna 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