Pathways to postoperative hostility in cardiac patients: Mediation of coping, spiritual struggle and Interleukin-6

Amy Lee Ai, Kenneth Pargament, Ziad Kronfol, Terrence N. Tice, Hoa Appel

Research output: Contribution to journalArticle

28 Citations (Scopus)


Using structural equation modeling, we estimated major pathways from preoperative distress, indicated by anxiety and other factors, to postoperative hostility in cardiac patients. Sequential interviews were conducted before and after surgery. Standardized medical and surgical indices were selected from a national database. Results showed that preoperative spiritual struggle mediated indirect effects of anxiety and anger coping on Interleukin-6 (IL-6) immediately before surgery. The link between spiritual struggle and IL-6 further mediated the indirect effects of anxiety and anger coping on postoperative hostility. Anger coping mediated the harmful influence of anxiety and counteracted the protection of positive religious coping on adjustment.

Original languageEnglish
Pages (from-to)186-195
Number of pages10
JournalJournal of Health Psychology
Issue number2
Publication statusPublished - 1 Mar 2010



  • Anger
  • Cardiac disease and open-heart surgery
  • Coping
  • Existential stress
  • Hostility
  • Interleukin-6 (IL-6)
  • Religion and spiritual struggle
  • Stress and mood state

ASJC Scopus subject areas

  • Applied Psychology

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