Impact of Positivity on Positive and Negative Affects by using Perceived

Stress as a Mediator among Cardiac Patients

ABSTRACT
Introduction: Number of factors are involved for the development of negative effects on
cardiovascular disorder. The psychosocial risk factors of cardiovascular diseases are negative
emotions which include depressive symptoms, anxiety, exhaustion, anger, and negative effect. A
high positive effectindependently relates with decreased cardiovascular diseases ratio, whereas
low positive affect predicts adverse cardiovascular consequences. Stress, a physiological
phenomenon which is prime factor to play a role in positivity. Positivity indicates self-esteem and
satisfaction with life, and through positivity, people deal with all difficulties of life easily.
Methods: Convenience sampling technique was used for data collection. A sample of 519 cardiac
patients was taken as research participants. A consent form was signed from all the cardiac patients
before study and questionnaire was provided to them to fill. The questionnaire had a scale from
positivity to perceived stress scale and affecting scale in negative and positive ways. The data was
analysed using SPSS software.
Results: is the results indicated that the perceived stress is the intermediate between positive effect
and negative effect. Furthermore, the perceived effect also intermediates between positivity and
positive effect while, the emotional relationship also affectsstress and negative effects. Positivity
has an opposite relationship with the negative effect. Finally, the perceived stress also has a
negative relationship with a positive effect whereas, the negativeeffect has a positive significant
relationship with perceived stress.
Conclusion: The positive emotions are helpful for the cardiac patients to reducing the negative
feelings which enhance the stress factor. Stress factor can be reduced by patient awareness, using
stress prevention strategies and well-being interventions.
Keywords: positivity, perceived stress, negative effects, counseling.

Introduction
The life is embedded with number of stress factor which play an important role in developing a
physical illness such as cardiovascular diseases. Previous reports indicated that unmanageable
stress depict problematic emotional regulations and ended up in germinating cardiac ailments
(Begley, 1994). The compelling psychosocial risk factors of cardiovascular diseases are negative
emotions which include anger and anxiety. Contrarily, the psychosocial factor which turns out to
be the cardioprotective potentials factor is positively affecting factor. Positive affect resulted in
enhancement of cheerfulness, life activity and joy in mood statesRoest, Marten, Denollet,et al,
2010; Melamed, Shirom,Toker, et al, 2006). A high positive effect has been independently related
to low cardiovascular diseases ratio whereas, a low positive affect predicts adverse cardiovascular
consequences like death even with percutaneous coronary intervention (Chida&Steptoe, 2008,
Versteeg,Spek, Pedersen, et al,2012; Denollet&Brutsaert, 2001). Different studies have shown that
cardiac patients preceding put less positive affect, resulted built-in anger, hostility and jealousy
ultimately prone to other cardiac complications. These people do not have smart and effective
coping strategies to confront the life stressors. (Low et al., 1998).
Positive psychologists have put great attention to create awareness for optimal well-being in
human functioning to fulfill the basic element of life e.g. satisfaction, self-esteem and optimism
which has positivity and positive effect. Positivity is defined as “a general tendency to view life
and experiences with a positive outlook” (Milioni,Alessandri, Eisenberg & Caprara, 2016;
Alessandri, Caprara & Tisak, 2012; Caprara, Eisenberg &Alessandri, 2017;Caprara, Fagnani,
Alessandri, et al, 2009). Enriched positivity is related to productive and adequate state of mood
and improve positive effectwith significantly decreased negative affect and
(Alessandri,Caprara,Tisak, 2012; Caprara, Alessandri, Eisenberg, et al, 2012;
Caprara,Eisenberg,Alessandri,2017 ).Previous studies have shown that positivity play a role to
improve the positive effect and reduce the negative effect of risk factors on life however; the
factors which contribute among these relationship are still need to investigate.. An impending
mediating variable is found to be “perceived stress in cardiac patients”. Lazarus and Folkman
postulates indicated that stress as “psychological and behavioral response to events appraised as
threatening and for which people lack sufficient resources to cope” (Lazarus & Folkman, 1984).
Perceived stress is the degree at which life situations are evaluated as stressful” (Cohen, Kamarck
&Mermelstein 1983).
According to the positive orientation theory, positivity response to stressors by regulating the use
of essential coping strategies (Alessandri,Caprara,Tisak, 2012;Caprara, Steca, Alessandri, Abela,
McWhinnie, 2010). Atanes, et al study has found a negative correlation between perceived stress,
negative affect and positive affect among non-cardiac patients (Atanes, 2015). Conversely, in
cardiac patients the effect of perceiving stress is more adverse with limited stress coping strategies
(Low et al., 1998).
(Li et al study has demonstrated the occupational stress and related outcomes in gender
differences (Li et al., 2015). Previous studies havedetermined the occupational stress as risk factors
for job burnout and proved that male candidates have better mental health thanfemale candidates.
Women havea higher rate of job burnout than the men as indicated in Chinese burnout index
survey. In these reports, the association among male and female employees to determine the role
of gender in positive relationships was examined. In the process of growth and development, the
psychological state is considered to produce desired results. Horiuchi et al reported that stress level
could be datermined by identifying physiological stress responses. Stress and coping are
independently associated with physiological stress responses (Horiuchi et al, 2018). Coping are
classified into four types included emotional expression, emotional seeking support, cognitive
reinterpretation and problem-solving. These are used as coping strategies to manage the difficulties
and un-expected harmful events of daily life. This study also indicated that due to stress number
of physiological problems occur, which may lead to the lower productivity and well-being of the
people in society.
Another report has shown that stress is the transactional process between human and their
environment (Gloria & Steinhardt, 2014). During stress conditions, the body triggers the fight or
flight moodstartagies to reduce stress response. Stress responses included high blood pressure,
heart rate,and respiration. The long-lasting stress increases the risk of many health
associtedproblems including cardiovascular disorders, obesity, immune diseases, depression,and
diabetes. In fact, anxiety and depression have a strong association with stress that mayincrease
themorbidity and mortality rate. Carmen Tabernero., et al. stated that the low socioeconomic status
and unemployment increasesthe stress factor which causes cardiaovascular disorders ultimately
increses the mortality rate (Carmen Tabernero., et al., 2017). Work load stress is another factor
which might induce the blood pressure,hypertension, and myocardial infarction.. Gender is also
considered as the variable which is related with cardiovascular diseases. It is to be stated that
women are most prone to this disease compared with men. Tuncay and collegues study showed
that environmental factors including life style might be the cause of increasing disease ratio (Tuncy
et al., 2008).
 The above reports provide us new concept that positivity is essential factor that reduced
the perceived stress by using coping tactics which consequently reduce negative affect and increase
positive affect in one’s life. So our study demonstrated the role of positivity on positive and
negative effect by using perceived stress as mediating factor and also haves howed the relationship
between these factor in cardiac patients.
Method
Participants
The data was collected from Institute of Cardiology Multan, Pakistan by using convenience
sampling technique. The population involved in the research study was the patients of the
Cardiology institute and a sample of 519 cardiac patients age ranged 20-73 year was chosen out
of the total population in order to collect the data for analysis.

Measuring Tools
Positivity Scale. In 2012, the scale of positivity was developed by Capra along with the Co-
workers. It is a single scale included eight items. This scale has used the five points which range
strongly disagree too strongly agree. This scale is considered reliable because its Cronbach alpha
is above 0.7. Scoring of this scale is obtained by the addition of all the points.
Perceived Stress Scale. Sumi et al developed the precieved stress scale which is single factor scale
measures purely the degree of stress perceived by the person in life situation in the past one month
(Sumi et al, 2015). This scale contains 14 items. Each item is rated at 5 pointsLikert scale which
ranges from 0 to 4. 0 to 4 states that that rating scales asks from never to very often about the
perceived stress. This scale was found to be valid and reliable because it's alpha value is above
0.7. The total of the scale is obtained by getting the sum of all items. The scoring method of this
scale instructs that higher scores on this scale illustrate higher levels of perceived stress in the
individual.
Negative and Positive Affect Schedule. This scale was developed by Sato and Yasuda in 2000
.This scale is consisting of two subscales namely negative and positive effect. Each subscale has
8 items which are measuring negative and positive affect individually. All the items have a rating
scale that ranges from 1 (never) to 6 (very often). The Cronbach alpha value of the scale is higher
than 0.7 which depicts higher reliability ratio of the scale. Total of each subscale is done first then
it is interpreting from the score which subscale sore is higher than the other. It shows that if score
is higher in subscale, then individual have more effect of that factor (Sato & Yasuda, 2000).

Procedure
A consent form was signed from all the cardiac patients before study and questionnaire
was provided to them to fill. The questionnaire included Positivity Scale, Perceived Stress Scale,
and Negative and Positive Affect Schedule. The time required to fill the questionnaires was 20-30
minutes. It was made sure to the participants that their results would remain confidential and it is
up to them whether they want to participate or not.
The participants were asked to complete the questionnaire on their own risk. Before taking the
participants they were briefed about the nature of the study and its usefulness to the society. Data
was collected and analyzed by using SPSS software to evaluate the results.

Step 1 Positivity c Positive affect

Negative affect

Perceived
Step 2 Stress
a b

Positivity c’ Positive Affect

Negative Affect

Figure 1. Theoretical model of the mediating role of positivity on the association between
perceived stress and positive and negative affect’s: associations of positivity with positive and
negative affect; a: associations of positivity with perceived stress; b: association between perceived
stress and positive and negative affect after controlling for the positivity; c’: associations of
positivity with positive and negative affect after adding perceived stress as a mediator.
Ethical Considerations
Various ethics were taken into consideration to carry out the study. An authority letter was
presented to the authority of the relevant universities explaining the nature of the study and
requested permission for the data collection. The written consent form was taken from all the
participants. The participants were also ensured regarding confidentiality and anonymity of all the
data collected from them. It was ensured that no physical or psychological distress was given to
the participants.

Discussion
Previous studies have demonstrated the effect of different physiological factors on cardiac
patients’ health status but the direct relationship of these factors with cardiac patients is indicated
in our study. The objective of present study was to determine the nature of the relationship that
exists between perceived stress, positivity, positive affect and negative effect in cardiac patients.
Our results indicated the role of different physiological factors in patients suffered with cardiac
disorder.
Correlation analysis showed positivity has a significant negative relationship with perceived stress
(r= -.704, p< .05) and has a significant positive relationship with positive affect (r= 0.112, p<.05).
The results also indicate that the positivity has a negative relationship with negative effect. The
perceived stress is also found to have a negative relationship with positive effect and the negative
effect has a positive relationship with perceived stress. The values of S.D indicate that responses
are scattered from the mean of each variable. Perceived stress scale has the highest mean obtained.
The mean on positivity was lower while the negativeeffect was seen more prevalent with a higher
mean value in comparison to positive effect. Current findings show that in cardiac patients,
positivity has a negative influence on the perceived stress and a significant positive
relationship.Our data reveals that perceived stress is the significant factor of negative affect in
cardiac patients.

Previous reports have shown that physiological factors and life situations directly related with
cardio vascular system (Begley, 1994). Different studies showed that cardiac patients are more
prone to stress which ultimately increase the negative effect factor. Results show that the total
effect of positivity and perceived stress was .112, which is significant and predicted the level and
effect the perceived stress on helath status. However, positivity directly connected withperceived
stresswhich increase the positive affect value up to -.315. These results suggested that perceived
stress might be the mediator between positivity and positive effect.
Many recent reports have shown that good mood with stress reliving strategies could be beneficial
for cardiac patients. Lockwood and colleague’s results have shown that using strategies like
humorto tagle the stress factors resulted less blood vessel blockage, less angioplasties, less heart
assaults, and more prominent life span at the point (Lockwood, 2011). It has been shown that the
experience of "charming" or mirthful feelings balances the pernicious, long haul physical impacts
of troubling feelings (Sultanoff, 1998). Consequently, these inquire about further recommend that
an entertaining way of life expands a person's capacity to additional successfully oversee
enthusiastic misery, accordingly diminishing the harming physical effect of these conceivably
unsafe feelings.

Our study also revealed that the positive effectand negative effect based on positivity and perceived
stress These results indicated that positivity decreases the perceived stress with increasing the
positive effect and lowering the negative effectinmalecardiac patients. Our results are consistent
with previous study on normal population that positivity reduce the level of negative effect which
further effect the perceived stress (Rosenbaum, White, &Gervino, 2012).
Taken together, our data provide compelling evidence that positivity is directly related with
perceived stress which increase the positive effect and reduce the negative effect among cardiac
patients.
The factors like stress has been found in the cardiac patients as the main factor which results in the
heart diseases. There are also many other factors like smoking and diet which are found by other
studies during their research. All these factors together increase the risk of heart diseases in human
beings. So, it is suggested that in order to minimize the threat of chronic heart diseases in our
society, it is important to spread awareness in the people about the causes and consequences of
heart diseases. Heart is the main organ in our body that is keeping us alive. It is working 24/7
without any rest. Hence, any problem in the working of heart may result in the death of a person.
When the people know that what are the factors that are causing heart diseases and their impact on
their lives, they would try to stay away from all such things.
To improve the psychosocial well-being of the patient suffering from cardiac problems are used
to counsel and support the patient. Interventions are implemented to manage stress and negative
effects. It is recommended that different indicators are used to determine positivity related to
personality traits. Patients are not treated therapeutically but counseling is also needed. Complete
medication makes the patient with negative outcomes and failure in complete recovery. Educating
the people that how to control the stress and the negative emotions might be beneficial for cardiac
patients. In this way the mortality rate of patient reduces.

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