ABSTRACT
Since the 1980s, there has been increasing evidence that psychosocial factors influence prognosis after a heart attack. Life stress (Ruberman, Weinblatt, Goldberg, & Chaudhary, 1984), psychological distress (Frasure-Smith, 1991), anxiety (Follick et al., 1988), depressive symptoms (Ahern et al., 1990), some aspect of type A behavior, hostility, or anger (Booth-Kewley & Friedman, 1987), and social support or its absence in the form of social isolation and loneliness (Case, Moss, Case, McDermott, & Eberly, 1992; Ruberman et al., 1984) have all been linked to poor outcomes following myocardial infarction (MI). For example, we carried out a study examining the long-term prognostic consequences of high levels of psychological distress in hospitals soon after an MI (Frasure-Smith, 1991). During hospitalization, 229 male patients responded to a standardized measure of psychological distress symptoms, the General Health Questionnaire or GHQ (Goldberg, 1972). Patients who reported 5 or more of the 20 GHQ symptoms were about 2.5 times as likely to die of cardiac causes over the subsequent 5 years as other patients (p=0.0003). This increase in risk remained even after controlling for other prognostic factors in the data set including history of coronary artery disease (CAD), ag, and the need for diamorphine for pain relief. Ahern and colleagues (1990) analysed data from the Cardiac Arrhythmia Pilot Study and found that scores on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), administered within 60 days after an MI, predicted 1-year cardiac death-arrest rates in a sample of 351 patients with significant arrhythmias at baseline. In Germany, data from 560 males involved in the Post-Infarction Late Potential Study showed that high degrees of depressive symptomatology in the hospital predicted cardiac deaths in the first 6 months following MI (Ladwig, Kieser, König, Breithardt, & Borggrefe, 1991).
