Psychosocial adjustment in patients after a first acute myocardial infarction: The contribution of salutogenic and pathogenic variables

Objective: To ascertain the differential and independent impact of sociodem ographic, medical, and psychologic variables assessed at patients' hospital discharge on these patients' psychosocial adjustment in several domains of life 3 to 6 months later. Design: Two-hundred ninety Israeli male patients, aged 30 to 65 years, with a documented first acute myocardial infarction (AMI) were interviewed once before discharge and again 3 to 6 months postinfarct. Sociodemographic, me dical, and psychologic data were elicited at the first interview and comple ted from medical information in the hospital files. Psychosocial adjustment in seven significant life domains was evaluated by the Psychosocial Adjust ment to Illness Scale-Self-Report Version (PAIS-SR) at the second interview . Hierarchical regression analysis was used to examine the relation between the sociodemographic, medical, and psychologic variables at discharge to p sychosocial adjustment in the different life domains 3 to 6 months later. Results: Psychologic variables, such as depression, sense of coherence, and social support, and the sociodemographic variable of educational level at discharge predicted a relatively substantial amount of variance in psychoso cial adjustment in most PAIS-SR-measured life domains. Low to moderate rela tions were found between such medical variables as Killip class, heart dise ase before AMI, other medical conditions, and perceived health before first AMI and psychosocial adjustment in specific life domains. The results also raised the possibility part of the impact of the medical variables at disc harge on psychosocial adjustment 3 to 6 months later may have been mediated by the psychologic variables. The centrality of the psychologic and domest ic life domains to psychosocial adjust ment in post-AMI patients was also s uggested by the results. Conclusions: Both external and internal pathogenic (depression) and health proneness variables (sense of coherence and social support) at discharge pr edict psychosocial adjustment in most life domains 3 to 6 months after AMI. (C) 1999 by the American Congress of Rehabilitation Medicine and the Ameri can Academy of Physical Medicine and Rehabilitation.