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Am Fam Physician. 2004;69(3):701-702

Various psychologic and social variables have been shown to affect patients with established coronary disease. The evidence is greatest for depression. Studies have suggested that anger issues and social support are important variables in the prognosis for these patients. Most studies in postmyocardial infarction patients have examined only one psychologic or social variable and used only one scale for evaluating patients' psychologic response. Single scales have a certain amount of error, and self-reporting negative emotions may be correlated with a tendency to experience or report negative emotions. Frasure-Smith and Lespérance examined the impact of depression symptoms, anxiety, anger, and social support in patients who have had an acute myocardial infarction.

The design was a cohort analytic study of patients admitted for acute myocardial infarction in 10 hospitals in a metropolitan area in Canada. Patients who met the inclusion criteria were asked to complete a Beck Depression Inventory, the state scale of the Spielberger State–Trait Anxiety Inventory, the 20-item version of the General Health Questionnaire, the Modified Somatic Perception Questionnaire, the Spielberger Anger Expression Scale, and the Perceived Social Support Scale. They were asked about the number of close friends and relatives they had, and they completed visual analog scales of anger and stress. Patients were followed for five years. The intervention was usual care for patients with myocardial infarction, and the main outcome measurement was five-year cardiac-related mortality.

A total of 896 patients 24 to 88 years of age participated in the study. Initial assessment of the data found that the Beck Depression Inventory, the Spielberger State–Trait Anxiety Inventory, and the 20-item version of the General Health Questionnaire were related to the outcome. When controlling for severity of cardiac disease, only depression remained significant. Three underlying factors identified by exploratory factor analysis had an impact on the outcome: negative affectivity, overt anger, and social support. Residual depression scores and negative affectivity scores also were linked to cardiac-related mortality after adjusting for each other and for cardiac covariants.

The authors conclude that negative affectivity and some aspects of depression predict long-term cardiac mortality after acute myocardial infarction. They add that cognitive behavior therapy or other structured psychotherapy and antidepressant therapy may be indicated to optimally target the psychologic risks identified in this study. Further research is needed to learn more about the relationships observed in this study and their implications for treatment.

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