{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:10:00Z","timestamp":1789017000602,"version":"build-2803163510"},"reference-count":85,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behav. Sci.","Behavioral Sciences"],"abstract":"<jats:p>Background: Acute cardiac events trigger multifaceted psychological responses captured by the construct of cardiac distress, a persistent negative emotional state involving multiple psychosocial domains. The Cardiac Distress Inventory (CDI) assesses this construct, but no Italian version exists. This study aimed to translate the CDI and assess its psychometric properties. Methods: After translation and back-translation, face validity was assessed with five patients and content validity with healthcare professionals. The CDI was administered to 293 patients who experienced a recent cardiac event from two Italian centers. Missing data were handled with multiple imputations. Exploratory factor analysis (EFA; principal axis factoring, oblimin rotation) assessed factorial structure. Criterion validity was assessed using correlations with Emotion Thermometers, Patient Health Questionnaire-4 (PHQ-4) and Kessler-6 (K6); ROC analysis assessed discriminative accuracy and the optimal cut-off. Results: The questionnaire demonstrated good face validity and suboptimal content validity (CVI-S\/Ave = 0.72). EFA revealed a five-factor structure explaining 54% of the variance: \u201cRole Change and Adaptation to Disease\u201d, \u201cEmotional Overwhelm, \u201cCognitive Challenges\u201d, \u201cSocial Disconnection\u201d, and \u201cHealth System Challenges\u201d. The final 46-item version showed good internal consistency (\u03c9 = 0.857\u20130.926) and discriminative accuracy (AUC = 0.84), with an optimal cut-off of 36 (sensitivity 71%, specificity 84%). Conclusions: The current study provides preliminary evidence for the validity of the Italian CDI. Additional studies are needed to confirm the proposed structures and clinical cut-offs.<\/jats:p>","DOI":"10.3390\/bs16091599","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:46:33Z","timestamp":1788875193000},"page":"1599","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Italian Adaptation and Psychometric Validation of the Cardiac Distress Inventory in Patients with Recent Cardiac Events"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9394-4227","authenticated-orcid":false,"given":"Graziano","family":"Gigante","sequence":"first","affiliation":[{"name":"Department of Psychology \u201cRenzo Canestrari\u201d, University of Bologna, Viale Carlo Berti Pichat, 5, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9286-1825","authenticated-orcid":false,"given":"Edward","family":"Callus","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy"},{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5828-4654","authenticated-orcid":false,"given":"Sara","family":"Gostoli","sequence":"additional","affiliation":[{"name":"Department of Psychology \u201cRenzo Canestrari\u201d, University of Bologna, Viale Carlo Berti Pichat, 5, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-5859","authenticated-orcid":false,"given":"Enrico Giuseppe","family":"Bertoldo","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Valentina","family":"Fiolo","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6278-0375","authenticated-orcid":false,"given":"Giulia","family":"Lorefice","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2292-8959","authenticated-orcid":false,"given":"Sofia","family":"De Stefano","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5441-3044","authenticated-orcid":false,"given":"Giulia","family":"Casu","sequence":"additional","affiliation":[{"name":"Department of Psychology \u201cRenzo Canestrari\u201d, University of Bologna, Viale Carlo Berti Pichat, 5, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Marco","family":"Monti","sequence":"additional","affiliation":[{"name":"Hospital Psychological Service, Bellaria Hospital, AUSL Bologna, Via Altura, 5, 40139 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Stefano","family":"Urbinati","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Bellaria Hospital, AUSL Bologna, Via Altura, 5, 40139 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-1399","authenticated-orcid":false,"given":"Alun Conrad","family":"Jackson","sequence":"additional","affiliation":[{"name":"Australian Centre for Heart Health, The Royal Melbourne Hospital, P.O. Box 2137, Melbourne, VIC 3050, Australia"},{"name":"School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia"},{"name":"Centre on Behavioral Health, The Centennial Campus, University of Hong Kong, CJT-706, 7\/F., The Jockey Club Tower, Pokfulam, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3025-7918","authenticated-orcid":false,"given":"Chiara","family":"Rafanelli","sequence":"additional","affiliation":[{"name":"Department of Psychology \u201cRenzo Canestrari\u201d, University of Bologna, Viale Carlo Berti Pichat, 5, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","first-page":"342","article-title":"Turkish version of the cardiac distress inventory and cardiac distress inventory short form: A validity and reliability study","volume":"53","author":"Jackson","year":"2025","journal-title":"Turk Kardiyoloji Dernegi Arsivi: Turk Kardiyoloji Derneginin Yayin Organidir"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/j.2044-8317.1950.tb00285.x","article-title":"Tests of significance in factor analysis","volume":"3","author":"Bartlett","year":"1950","journal-title":"British Journal of Statistical Psychology"},{"key":"ref_3","unstructured":"Bates, D., Maechler, M., and Jagan, M. (2026, August 11). Matrix: Sparse and dense matrix classes and methods, Available online: https:\/\/CRAN.R-project.org\/package=Matrix."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3186","DOI":"10.1097\/00007632-200012150-00014","article-title":"Guidelines for the process of cross-cultural adaptation of self-report measures","volume":"25","author":"Beaton","year":"2000","journal-title":"Spine"},{"key":"ref_5","unstructured":"Bryant, F. B., and Yarnold, P. R. (1995). Principal-components analysis and exploratory and confirmatory factor analysis. Reading and understanding multivariate statistics, American Psychological Association."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4156","DOI":"10.1093\/eurheartj\/ehaf191","article-title":"2025 ESC clinical consensus statement on mental health and cardiovascular disease: Developed under the auspices of the ESC clinical practice guidelines committee: Developed by the task force on mental health and cardiovascular disease of the European society of cardiology (ESC) endorsed by the European federation of psychologists\u2019 associations AISBL (EFPA), the European psychiatric association (EPA), and the international society of behavioral medicine (ISBM)","volume":"46","author":"Bueno","year":"2025","journal-title":"European Heart Journal"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1207\/s15327906mbr2704_2","article-title":"Remarks on parallel analysis","volume":"27","author":"Buja","year":"1992","journal-title":"Multivariate Behavioral Research"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.eurpsy.2010.04.008","article-title":"Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country","volume":"26","author":"Sciarini","year":"2011","journal-title":"European Psychiatry: The Journal of the Association of European Psychiatrists"},{"key":"ref_9","first-page":"127","article-title":"Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior","volume":"86","author":"Cicchetti","year":"1981","journal-title":"American Journal of Mental Deficiency"},{"key":"ref_10","unstructured":"Consiglio Nazionale Ordine degli Psicologi (2025, November 10). Interventi psicologici in cardiologia: Indicazioni per la pratica professionale e per un nuovo approccio normativo, Available online: https:\/\/www.psy.it\/interventi-psicologici-in-cardiologia-indicazioni-per-la-pratica-professionale\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1177\/0013164410379332","article-title":"Evaluation of parallel analysis methods for determining the number of factors","volume":"70","author":"Crawford","year":"2010","journal-title":"Educational and Psychological Measurement"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1108\/09604520710744326","article-title":"Perceived e-service quality (PeSQ): Measurement validation and effects on consumer satisfaction and web site loyalty","volume":"17","author":"Cristobal","year":"2007","journal-title":"Managing Service Quality"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"195","DOI":"10.4103\/tjem.tjem_182_23","article-title":"Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value","volume":"23","author":"Aksel","year":"2023","journal-title":"Turkish Journal of Emergency Medicine"},{"key":"ref_14","first-page":"476","article-title":"The psychometric evaluation of the Italian version of the surgical fear questionnaire in adult patients waiting for major cardiac surgery","volume":"36","author":"Damico","year":"2024","journal-title":"Annali Di Igiene: Medicina Preventiva E Di Comunita"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Debelak, R., and Tran, U. S. (2016). Comparing the effects of different smoothing algorithms on the assessment of dimensionality of ordered categorical items with parallel analysis. PLoS ONE, 11, (2).","DOI":"10.1371\/journal.pone.0148143"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e022354","DOI":"10.1161\/JAHA.121.022354","article-title":"Conceptual framework for personal recovery in patients with acute myocardial infarction","volume":"10","author":"Dreyer","year":"2021","journal-title":"Journal of the American Heart Association"},{"key":"ref_17","unstructured":"Dueber, D. (2026, August 11). BifactorIndicesCalculator: Bifactor indices calculator, Available online: https:\/\/CRAN.R-project.org\/package=BifactorIndicesCalculator."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1007\/s10072-013-1438-1","article-title":"Adherence to anti-Parkinson drug therapy in the \u201cREASON\u201d sample of Italian patients with Parkinson\u2019s disease: The linguistic validation of the Italian version of the \u201cMorisky medical adherence scale-8 items\u201d","volume":"34","author":"Fabbrini","year":"2013","journal-title":"Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s11739-021-02780-2","article-title":"Validation of the Italian HeartQoL: A short health-related quality of life questionnaire for patients with ischemic heart disease","volume":"17","author":"Fattirolli","year":"2022","journal-title":"Internal and Emergency Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1159\/000448856","article-title":"Current psychosomatic practice","volume":"86","author":"Fava","year":"2017","journal-title":"Psychotherapy and Psychosomatics"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fong, T. C. T., Leung, I. C. H., Wong, C. K., Jackson, A. C., and Ho, R. T. H. (2024). Psychometric validation of the cardiac distress inventory\u2014Short form among people with cardiac diseases in Hong Kong. Frontiers in Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1412264"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/HCR.0b013e31818c3c51","article-title":"Patterns of psychosocial adjustment following cardiac surgery","volume":"28","author":"Genardini","year":"2008","journal-title":"Journal of Cardiopulmonary Rehabilitation and Prevention"},{"key":"ref_23","unstructured":"Ghisi, M., Flebus, G. B., Montano, A., Sanavio, E., and Sica, C. (2006). Beck depression inventory-second edition. Adattamento italiano: Manuale, Giunti Psychometrics."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"112708","DOI":"10.1016\/j.jpsychores.2026.112708","article-title":"Assessing cardiac distress in Italian patients: Translation and validation of the cardiac distress inventory, a comprehensive psychosomatic tool","volume":"207","author":"Gigante","year":"2026","journal-title":"Journal of Psychosomatic Research, EAPM"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1080\/08870446.2020.1830093","article-title":"Examination of the best cut-off points of PHQ-2 and GAD-2 for detecting depression and anxiety in Italian cardiovascular inpatients","volume":"36","author":"Giuliani","year":"2021","journal-title":"Psychology & Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1177\/0013164495055003002","article-title":"An improvement on Horn\u2019s parallel analysis methodology for selecting the correct number of factors to retain","volume":"55","author":"Glorfeld","year":"1995","journal-title":"Educational and Psychological Measurement"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3510","DOI":"10.1007\/s12144-019-00300-2","article-title":"Exploratory factor analysis: Current use, methodological developments and recommendations for good practice","volume":"40","author":"Goretzko","year":"2021","journal-title":"Current Psychology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1002\/cncr.27902","article-title":"Screening for distress in cancer patients: A multicenter, nationwide study in Italy","volume":"119","author":"Grassi","year":"2013","journal-title":"Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"165","DOI":"10.21449\/ijate.827950","article-title":"Item removal strategies conducted in exploratory factor analysis: A comparative study","volume":"9","year":"2022","journal-title":"International Journal of Assessment Tools in Education"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1002\/pon.5172","article-title":"A systematic review on the use of the emotion thermometer in individuals diagnosed with cancer","volume":"28","author":"Harju","year":"2019","journal-title":"Psycho-Oncology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/01.HCR.0000291296.62894.e5","article-title":"Emotional and adjustment issues faced by cardiac patients seen in clinical practice: A qualitative survey of experienced clinicians","volume":"27","author":"Higgins","year":"2007","journal-title":"Journal of Cardiopulmonary Rehabilitation and Prevention"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/imanum\/22.3.329","article-title":"Computing the nearest correlation matrix\u2014A problem from finance","volume":"22","author":"Higham","year":"2002","journal-title":"IMA Journal of Numerical Analysis"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s11135-008-9190-y","article-title":"Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables","volume":"44","year":"2010","journal-title":"Quality & Quantity"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/BF02289447","article-title":"A rationale and test for the number of factors in factor analysis","volume":"30","author":"Horn","year":"1965","journal-title":"Psychometrika"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Jackson, A. C., Le Grande, M. R., Rogerson, M. C., Ski, C. F., Amerena, J., Smith, J. A., Hoover, V., Alvarenga, M. E., Higgins, R. O., Thompson, D. R., and Murphy, B. M. (2022a). The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event. BMC Cardiovascular Disorders, 22, (1).","DOI":"10.1186\/s12872-022-02897-y"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"286","DOI":"10.12968\/bjca.2018.13.6.286","article-title":"What is cardiac distress and how should we measure it?","volume":"13","author":"Jackson","year":"2018","journal-title":"British Journal of Cardiac Nursing"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Jackson, A. C., Rogerson, M. C., Amerena, J., Smith, J., Hoover, V., Alvarenga, M. E., Higgins, R. O., Le Grande, M. R., Ski, C. F., Thompson, D. R., and Murphy, B. M. (2022b). Unraveling the complexity of cardiac distress: A study of prevalence and severity. Frontiers in Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.808904"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/001316447403400115","article-title":"Little jiffy, mark Iv","volume":"34","author":"Kaiser","year":"1974","journal-title":"Educational and Psychological Measurement"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jad.2022.12.055","article-title":"Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis","volume":"324","author":"Karami","year":"2023","journal-title":"Journal of Affective Disorders"},{"key":"ref_40","first-page":"613","article-title":"An ultra-brief screening scale for anxiety and depression: The PHQ-4","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"123","DOI":"10.5709\/acp-0391-2","article-title":"The patient health questionnaire\u20134: Factor structure, measurement invariance, latent profile analysis of anxiety and depressive symptoms and screening results in polish adults","volume":"19","author":"Larionow","year":"2023","journal-title":"Advances in Cognitive Psychology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Le Grande, M. R., Murphy, B. M., Rogerson, M. C., Ski, C. F., Amerena, J., Smith, J. A., Hoover, V., Alvarenga, M. E., Higgins, R. O., Thompson, D. R., and Jackson, A. C. (2023). Development of a short form of the cardiac distress inventory. BMC Cardiovascular Disorders, 23, (1).","DOI":"10.1186\/s12872-023-03439-w"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1080\/10705511.2020.1735393","article-title":"Not positive definite correlation matrices in exploratory item factor analysis: Causes, consequences and a proposed solution","volume":"28","author":"Ferrando","year":"2021","journal-title":"Structural Equation Modeling: A Multidisciplinary Journal"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1027\/1614-2241.2.2.57","article-title":"Tucker\u2019s congruence coefficient as a meaningful index of factor similarity","volume":"2","year":"2006","journal-title":"Methodology: European Journal of Research Methods for the Behavioral and Social Sciences"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jad.2009.06.019","article-title":"A 4-item measure of depression and anxiety: Validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population","volume":"122","author":"Wahl","year":"2010","journal-title":"Journal of Affective Disorders"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00006199-198611000-00017","article-title":"Determination and quantification of content validity","volume":"35","author":"Lynn","year":"1986","journal-title":"Nursing Research"},{"key":"ref_47","unstructured":"McDonald, R. P. (1999). Test theory: A unified treatment, Psychology Press."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.3758\/s13428-020-01398-0","article-title":"Thinking twice about sum scores","volume":"52","author":"McNeish","year":"2020","journal-title":"Behavior Research Methods"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.jad.2011.06.008","article-title":"Validation of simple visual-analogue thermometer screen for mood complications of cardiovascular disease: The emotion thermometers","volume":"136","author":"Mitchell","year":"2012","journal-title":"Journal of Affective Disorders"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1207\/s15327574ijt0502_4","article-title":"Minimum sample size recommendations for conducting factor analyses","volume":"5","author":"Mundfrom","year":"2005","journal-title":"International Journal of Testing"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Murphy, B., Le Grande, M., Alvarenga, M., Worcester, M., and Jackson, A. (2019). Anxiety and depression after a cardiac event: Prevalence and predictors. Frontiers in Psychology, 10.","DOI":"10.3389\/fpsyg.2019.03010"},{"key":"ref_52","first-page":"826","article-title":"Patients want to know about the \u2018cardiac blues\u2019","volume":"44","author":"Murphy","year":"2015","journal-title":"Australian Family Physician"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Murphy, B. M., Rogerson, M. C., Hesselson, S., Iismaa, S. E., Graham, R. M., and Jackson, A. C. (2022). Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study. PLoS ONE, 17, (9).","DOI":"10.1371\/journal.pone.0273978"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Obeid, S., Hemade, A., Malaeb, D., Sakr, F., Dabbous, M., Xu, J., Ying, Y., Jiang, C., Meng, R., Fekih-Romdhane, F., and Hallit, S. (2024). Psychometric properties of the ultra-brief self-report patient health questionnaire-4 (PHQ-4) to assess anxiety and depression in arabic-speaking adults. BMC Psychiatry, 24, (1).","DOI":"10.1186\/s12888-024-05978-8"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1159\/000531260","article-title":"Illness denial in medical disorders: A systematic review","volume":"92","author":"Patierno","year":"2023","journal-title":"Psychotherapy and Psychosomatics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1159\/000447760","article-title":"Use of the psychosocial index: A sensitive tool in research and practice","volume":"85","author":"Piolanti","year":"2016","journal-title":"Psychotherapy and Psychosomatics"},{"key":"ref_57","unstructured":"Posit Team (2026, August 11). RStudio: Integrated development environment for R [Posit software]. PBC, Available online: http:\/\/www.posit.co\/."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.eurpsy.2010.12.006","article-title":"Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample","volume":"27","author":"Prunas","year":"2012","journal-title":"European Psychiatry: The Journal of the Association of European Psychiatrists"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"Quan","year":"2011","journal-title":"American Journal of Epidemiology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1136\/spcare-2022-003884","article-title":"Depression prevalence in cardiovascular disease: Global systematic review and meta-analysis","volume":"13","author":"Rafiei","year":"2023","journal-title":"BMJ Supportive & Palliative Care"},{"key":"ref_61","unstructured":"R Core Team (2025). R: A language and environment for statistical computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_62","unstructured":"Revelle, W. (2025). psych: Procedures for psychological, psychometric, and personality research, Northwestern University. Available online: https:\/\/CRAN.R-project.org\/package=psych."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.-C., and M\u00fcller, M. (2011). pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics, 12.","DOI":"10.1186\/1471-2105-12-77"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/00223891.2015.1089249","article-title":"Applying bifactor statistical indices in the evaluation of psychological measures","volume":"98","author":"Rodriguez","year":"2016","journal-title":"Journal of Personality Assessment"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: Update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"Journal of the American College of Cardiology"},{"key":"ref_66","unstructured":"Rubin, D. B. (2018). Multiple imputation. Flexible imputation of missing data, Chapman and Hall\/CRC. [2nd ed.]."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"231","DOI":"10.23736\/S2724-5683.21.05538-9","article-title":"Cardiovascular disease burden. Italian and global perspectives","volume":"69","author":"Saglietto","year":"2021","journal-title":"Minerva Cardiology and Angiology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/10705511.2011.557339","article-title":"What to do about zero frequency cells when estimating polychoric correlations","volume":"18","author":"Savalei","year":"2011","journal-title":"Structural Equation Modeling: A Multidisciplinary Journal"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/01.ede.0000147512.81966.ba","article-title":"Optimal cut-point and its corresponding Youden index to discriminate individuals using pooled blood samples","volume":"16","author":"Schisterman","year":"2005","journal-title":"Epidemiology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/BF02289209","article-title":"The development of hierarchical factor solutions","volume":"22","author":"Schmid","year":"1957","journal-title":"Psychometrika"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"11804","DOI":"10.1038\/s41598-025-96968-7","article-title":"Loneliness and repetitive negative thinking mediate the link between social health and cardiac distress in heart disease patients","volume":"15","author":"Jackson","year":"2025a","journal-title":"Scientific Reports"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"17011","DOI":"10.1038\/s41598-025-02092-x","article-title":"Evaluation of the psychometric properties of the cardiac distress inventory in Iranian patients with heart disease","volume":"15","author":"Jackson","year":"2025b","journal-title":"Scientific Reports"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1093\/eurjcn\/zvaf057","article-title":"Psychological screening in cardiovascular care","volume":"24","author":"Ski","year":"2025","journal-title":"European Journal of Cardiovascular Nursing"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"101877","DOI":"10.1016\/j.cpcardiol.2023.101877","article-title":"Global prevalence of anxiety in adult cardiology outpatients: A systematic review and meta-analysis","volume":"48","author":"Storer","year":"2023","journal-title":"Current Problems in Cardiology"},{"key":"ref_75","unstructured":"Tabachnick, B. G., and Fidell, L. S. (2014). Using multivariate statistics, Pearson Education. [6th ed.]."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Tucker, L. R. (1951). A method for synthesis of factor analysis studies, Defense Technical Information Center.","DOI":"10.21236\/AD0047524"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"van Buuren, S. (2018). Flexible imputation of missing data, Chapman and Hall\/CRC. [2nd ed.].","DOI":"10.1201\/9780429492259"},{"key":"ref_78","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R","volume":"45","year":"2011","journal-title":"Journal of Statistical Software"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/BF02293557","article-title":"Determining the number of components from the matrix of partial correlations","volume":"41","author":"Velicer","year":"1976","journal-title":"Psychometrika"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0095798418771807","article-title":"Exploratory factor analysis: A guide to best practice","volume":"44","author":"Watkins","year":"2018","journal-title":"Journal of Black Psychology"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Wickham, H. (2016). ggplot2: Elegant graphics for data analysis, Springer. Available online: https:\/\/ggplot2.tidyverse.org.","DOI":"10.1007\/978-3-319-24277-4_9"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Worcester, M. U. (2015). In-hospital management of psychological responses to acute cardiac events. Handbook of psychocardiology, Springer.","DOI":"10.1007\/978-981-4560-53-5_51-1"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, (20), 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1177\/0193945903252998","article-title":"Two quantitative approaches for estimating content validity","volume":"25","author":"Wynd","year":"2003","journal-title":"Western Journal of Nursing Research"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/emip.12604","article-title":"Revisiting the usage of alpha in scale evaluation: Effects of scale length and sample size","volume":"43","author":"Xiao","year":"2024","journal-title":"Educational Measurement: Issues and Practice"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1599\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:45:31Z","timestamp":1789015531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":85,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["bs16091599"],"URL":"https:\/\/doi.org\/10.3390\/bs16091599","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}