Psychosocial factors and myocardial infarction--why and how?

Physical activity at work and job responsibility as risk factors for fatal coronary heart disease and other causes of death

Altogether 99 029 men aged 40-59, employed on the Italian railroad system, were classified in three levels of physical activity at work and three levels of job responsibility and then followed up for five years in terms of mortality and cause of death. Physical activity and job responsibility have been investigated in different ways as possible risk factors of lethal events. When considering together the findings of univariate and bivariate analyses it appears that low physical activity and high job responsibility are attributes favouring myocardial infarction, and that high physical activity and low job responsibility are attributes favouring lethal chronic bronchitis and violent death. Overall, mortality from all causes is not significantly different in different classes of physical activity and job responsibility, and within total mortality these two characteristics play a role in the distribution of the various causes of death as a consequence of possible competing risks. A number of other non-measured factors, however, may have had a confounding effect.

Psychosocial outcome one year after a first myocardial infarction

Psychosocial outcome in terms of mental state, health preoccupation, leisure activity, avoidance behaviour, sexual activity and attitude towards life and the future one year after a myocardial infarction (MI) was studied in 177 consecutive male, able-bodied patients below 61 yr of age with a first MI. Questionnaires and a brief interview covered the psychological and social data while the somatic variables were recorded in a standardized medical examination. Emotional distress, self-reported symptoms, avoidance behaviour, overprotection, pessimism and a diminished sexual activity were frequent, indicating a poor adaptation. These disturbances were apparent two months after the MI and remained stable. Psychological factors were stronger determinants of maladjustment than smoking, angina pectoris and recorded somatic illness. Neither severity of the infarction nor social and demographic factors determined maladjustment. Intervention must take place early and be directed to psychological factors as well as to the cardiac condition.

Psychosocial stress and ischaemic heart disease: a response to tennant

In a recent article appearing in this journal, a decision of the Administrative Appeals Tribunal granting a war pension for ischaemic heart disease arising out of the stresses of military service in World War II was severely criticised. The following is a literature review supporting the Tribunal's judgement by providing evidence for an association between both neurotic illness and stresses of varying severity on the one hand and cardiovascular disease on the other.

Psychosocial factors and myocardial infarction

Two questionnaires totalling 370 questions were used to compare 61 male patients who had survived a first myocardial infarction with a group controlled for age and social status who had not had an infarction. The questionnaires included the Edwards Personal Preference Schedule, providing a measure of 15 personality variables, the Anxiety and Depression Sub-Scales of the MMPI, and the Cochrane and Robertson Life Events Inventory, as well as originally-designed questions based on known risk factors. Significant differences were found in several dimensions of personality as well as in the family histories of myocardial infarction and in certain life styles. The patient group showed a greater sense of independence, greater difficulty in relaxing, and a sence of personal inferiority. Suggestions are offered for the modification of life styles in susceptible individuals as a possible aid to prevention.