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. 2025 Apr 14;15(4):528.
doi: 10.3390/bs15040528.

Depressive and Anxiety Symptoms, Defense Mechanisms, and Mentalized Affectivity in Individuals with Myocardial Infarction: An Empirical Investigation

Gianluca Cruciani  1 , Gabriele Lo Buglio  2 , Annalisa Tanzilli  2 , Marianna Liotti  2   3 , Matteo Scalzeri  2 , Gaetano Tanzilli  4 , Federica Galli  2 , Vittorio Lingiardi  2
Affiliations

Depressive and Anxiety Symptoms, Defense Mechanisms, and Mentalized Affectivity in Individuals with Myocardial Infarction: An Empirical Investigation

Gianluca Cruciani et al. Behav Sci (Basel). .

Abstract

Myocardial infarction (MI) is associated with emotional distress, depression, and anxiety. Defense mechanisms and mentalized affectivity play key roles in affective regulation; however, their roles in individuals with MI remain underexplored. This study examined the relationship between depressive and anxiety symptoms, defensive functioning, and mentalized affectivity in MI patients. Sixty-seven patients with MI and 80 healthy controls completed the DSM-5 Self-Rated Level 2 Cross-Cutting Symptom Measures-Depression and Anxiety-Adult, the Defense Mechanisms Rating Scales-Self-Report-30, and the Brief-Mentalized Affectivity Scale. Multivariate analyses were used to compare the MI and healthy groups, while correlations and mediation models were used to evaluate associations between variables within the MI group. Compared to controls, patients with MI exhibited more severe depressive and anxiety symptoms, maladaptive defenses, and lower levels of mentalized affectivity. Within the MI group, the severity of depressive and anxiety symptoms was associated with immature defensive functioning and poorer abilities to regulate affects. Notably, the relationship between worse defensive functioning and severe depressive and anxiety symptoms was mediated by the capacity to process emotions. The mediating role of this specific dimension of mentalized affectivity emphasizes the potential of affect regulation as a target for tailored psychosocial interventions aimed at improving clinical outcomes.

Keywords: anxiety; defense mechanisms; depression; mentalized affectivity; myocardial infarction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Graphical representation of the GLM mediation model assessing the direct and indirect effects of overall defensive functioning (assessed using the DMRS-SR-30) on depressive symptoms (assessed using the DSM-5-D) through emotion processing (assessed using the B-MAS) in patients with MI (N = 67). * p ≤ 0.05. ** p ≤ 0.01. *** p ≤ 0.001.
Figure 2
Figure 2
Graphical representation of the GLM mediation model assessing the direct and indirect effects of overall defensive functioning (assessed with the DMRS-SR-30) on anxiety symptoms (assessed with the DSM–5–A) through emotion processing (assessed with the B-MAS) in patients with MI (N = 67). ** p ≤ 0.01. *** p ≤ 0.001.
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