Cardiologists’ attitudes toward psychological care: a national survey on perceptions, collaboration and barriers

Background: Despite evidence of a bidirectional relationship between cardiac and mental health, psychological care remains insufficiently integrated into cardiology practice. This study explored cardiologists' perceptions and attitudes toward the role of psychology in cardiovascular disease (CVD) care. Methods: We conducted an online cross-sectional survey of cardiologists affiliated with the Italian National Association of Hospital Cardiologists (ANMCO). The questionnaire assessed their experiences with psychologists, attitudes toward managing psychological distress in CVD, perceived barriers to referral, and attitudes toward psychological help. Results: Of 268 cardiologists who accessed the survey, 218 (mean age 54.0 ± 13.8 years) completed it. Although 96.3% acknowledged the relevance of psychological factors to CVD management and treatment, 33.9% reported never having collaborated with a psychologist, and 39.0% reported withholding psychological referrals despite recognizing patient need. Major barriers included concern that patients might interpret a referral as minimization of somatic symptoms or that it could reinforce stigma. Overall, 64.2% had never received training on psychological aspects of CVD, although interest in such training was high (≥82.6%). Prior collaboration with psychologists and more positive help-seeking attitudes were associated with greater perceived usefulness of psychological care. Conclusions: Cardiologists recognize the importance of psychological factors, yet educational, structural, and cultural barriers limit the integration of psychological interventions into cardiovascular care. Targeted training, clear communication strategies, and stronger interprofessional collaboration may improve patient outcomes and advance a biopsychosocial approach in cardiology.