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.