Which coping classifications-problem versus emotion or engaged versus disengaged-best predict psychological distress in individuals with cardiac diseases? A systematic review and meta-analysis.

OBJECTIVE

This study systematically synthesized evidence on the associations between coping strategies and psychological distress, specifically anxiety and depression, among individuals with cardiac diseases. It further assessed whether coping classifications based on engagement (engaged vs. disengaged) or focus (problem- vs. emotion-focused) better predicted emotional distress.

METHOD: Nineteen eligible studies were analyzed using a three-level meta-analytic model. Effect sizes were grouped by coping strategy and outcome, and moderator analyses tested the influence of publication year and correlation type (bivariate vs. partial).

RESULTS

Disengaged coping was moderately to strongly associated with anxiety (r = .39) and a moderate association with depression (r = .34). Emotion-focused coping was moderately associated with anxiety (r = .32) and weaker links with depression (r = .22). Engaged coping showed a small but significant association with anxiety (r = .17); other associations with engaged and problem-focused coping were nonsignificant. Significant heterogeneity was observed across studies. Year of publication moderated the link between problem-focused coping and depression: Studies published before 2007 showed a positive association (r = .20), whereas those published after 2007 showed a negative one (r = -.15).

CONCLUSIONS

Disengaged and emotion-focused coping strategies were consistently associated with greater psychological distress among cardiac patients. In contrast, engaged and problem-focused strategies had weaker and more variable associations. Overall, the engaged-disengaged classification was a better predictor of emotional distress in this population. Findings emphasize the need to target maladaptive coping in interventions for individuals with cardiac diseases. (PsycInfo Database Record (c) 2026 APA, all rights reserved).