Independent importance of psychosocial factors for prognosis after myocardial infarction

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 su pport, 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 m orbidity and cause-specific mortality. Baseline somatic and psychosocial va riables were collected with the aid of standard, validated questionnaires. Results. In multivariate analysis, factors increasing risk for coronary mor tality 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), ventric ular dysrhythmia 3 months after the infarction 5.45 (2.21, 13.42), high dep ression scores 3.16 (1.38, 7.25) and lack of social support 2.75 (1.29, 5.8 9). All-cause mortality was significantly related to left ventricular failu re, ventricular dysrhythmias, and high depression scores with borderline si gnificance 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 mar riage, anxiety, dissatisfaction with family life, problems with children, d issatisfaction with the financial situation, life events, anger-in, irritab ility, 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 my ocardial infarction, prognosis is strongly influenced by depression and lac k of social support, but not to a series of other psychosocial factors. It is recommended to use self-reporting scales to detect prognostically import ant psychosocial problems.