Independent importance of psychosocial factors for prognosis after myocardial infarction

Abstract

Abstract. Welin C, Lappas G, Wilhelmsen L (Heart and Lung Institute, Göteborg University, Göteborg, Sweden). Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 2000; 247: 629–639. Aims. As a primary aim it was tested whether the 10‐year prognosis after a myocardial infarction is related to psychological stress, lack of social support, anxiety, and/or depressive tendency. A secondary aim was to analyse the prognostic importance of a series of other psychosocial factors as well as interactions. Methods. Non‐selected patients aged below 65 years with a first infarction (230 men and 45 women) were followed for 10 years with 100% assessment of morbidity and cause‐specific mortality. Baseline somatic and psychosocial variables were collected with the aid of standard, validated questionnaires. Results. In multivariate analysis, factors increasing risk for coronary mortality included female sex (hazard ratio, ± 95% confidence interval) 2.47 (1.06, 5.71), signs of left ventricular failure 3.93 (1.87, 8.26), ventricular dysrhythmia 3 months after the infarction 5.45 (2.21, 13.42), high depression scores 3.16 (1.38, 7.25) and lack of social support 2.75 (1.29, 5.89). All‐cause mortality was significantly related to left ventricular failure, ventricular dysrhythmias, and high depression scores with borderline significance for female sex and social support. Prognosis was affected during the entire follow‐up period. It was not significantly associated with age, marital status, education, extra work, mental strain at work or in the marriage, anxiety, dissatisfaction with family life, problems with children, dissatisfaction with the financial situation, life events, anger‐in, irritability, type A behaviour, or health locus of control. Incidence of nonfatal infarction was not associated with any of the baseline variables. Conclusion. In addition to known somatic predictors of prognosis after a myocardial infarction, prognosis is strongly influenced by depression and lack of social support, but not to a series of other psychosocial factors. It is recommended to use self‐reporting scales to detect prognostically important psychosocial problems.