Return to work after a heart attack☆,☆☆

Despite the growing amount of reseach on cardiac disease and sexual dysfunction, few empirical studies have been published on the overlap of these 2 areas. In particular, previous research has noted that the overall attainment of social and occupational adjustment for patients with cardiac disease remains a challenge. Emotional distress of sufficient intensity to receive a psychiatric diagnosis has been estimated to be as high as 37–58% in patients after myocardial infarction (MI). In fact, numerous studies have concluded that failure to adjust socially or to return to normal activity levels is more strongly related to psychological distress than to the extent of the organic disease itself. These factors, either pre-existing or after onset of psychological morbidity, are highly likely to influence sexual adjustment of the cardiac patient. This article reviews the role of anxiety as a risk factor for the development of cardiac disease, as a comorbid condition, and the role anxiety may play in the development of sexual difficulties. The complicated association between psychological distress, previous sexual adjustment, organic factors, and existing family supports should be considered in cardiac rehabilitation.

We investigated psychosocial and clinical factors related to work resumption, delay in returning to work and level of work activity after an acute myocardial infarction in Japanese male patients. A total of 111 married male patients experiencing a first acute myocardial infarction, aged less than 66 years and in full-time employment participated. Interviews and questionnaires were administered during hospitalization to assess potential predictors of work-related outcomes, with follow-up (81.6%) after an average of 8 months. We found that failure to return to work was predicated independently by older age (P=0.019), an introverted personality (P=0.011) and the presence of depressive symptoms during hospitalization (P=0.031). Delay in returning to work was predicted by greater concerns about health (P=0.011), low social support (P=0.021), and a failure to recognise a link between stress, coping style and illness (P=0.001). Resuming work at a lower activity level than before infarction was associated with older age (P=0.008), higher health concerns (P=0.012), and patients’ predictions of their lower work activity (P=0.001). Clinical indices of infarction size and disease severity did not predict work-related outcomes. We conclude that psychosocial factors are associated with work resumption in Japanese men characterised by a job-centred lifestyle, with different factors being important for different work outcomes. The psychosocial factors found to be important are similar to those identified in Western societies.

In this study, we assess the adjustment achieved by patients following discharge from coronary care and the role of socioeconomic status (SES), social environment (SE), and depression in achieving that adjustment. Two hundred eighty-seven patients were enrolled. The SE into which the patients were to be discharged was rated signficantly poorer for patients of lower SES, who also scored higher on depression. At 1, 6, and 12 months postdischarge, lower SES patients recorded significantly poorer levels of adjustment across a range of functioning. Predischarge depression, together with measures of SE and SES, determined 10% to 28% of the variance in 12-month postdischarge adjustment. These data suggest the importance of identifying patients at greater risk for less than optimal outcome (those lower in SES and higher in depression), and the need to address the nature of the SE in which the patient has to effect his/her recovery.

When a patient has a myocardial infarction (MI), all aspects of marital function are affected. Soon after the MI, patients’ wives experience psychological distress that decreases with time. Illness behaviors among the MI patients’ wives increase, and aggressive and sexual impulses are often inhibited. Many families experience changes in members’ work status after the husband has an MI, and wives are faced with increased chores. Marital interaction also changes. Dysfunctional marital relationships are associated with a poor psychosocial outcome. Additionally, spousal factors such as dependency are also likely to affect patients. Intervention strategies are best directed to wives at risk for problems.

In a prospective study of 283 myocardial infarction (MI) patients, state-dependent feelings of anxiety, depression, and irritability were assessed twice during hospital stay, and four times during a 3–5 yr follow-up.

A K-mean cluster analysis identified six subgroups of MI patients with different pattern of emotional reactions. Two groups, containing nearly half of the sample, had low average levels of emotional upset at all assessments. Two groups showed an intermediate long-term outcome: one of these had a high level of initial emotional upset that subsided during the first six months after discharge, whereas the other group showed increasing levels of emotional distress long-term follow-up. Finally, two groups failed to achieve long-term emotional readjustment. For one of these, a high level of emotional upset was evident from the first in-hospital assessment, whereas the other one had a sharp increase in emotional distress after discharge. In a series of psychological, social and medical variables, the former pattern was associated with more pre-MI medical and psychosocial problems, whereas the delayed emotional reaction was related to lower levels of cardiac health knowledge. Furthermore, high levels of emotional upset preceded both failure in resuming work and increased long-term rehospitalization.

The findings indicate that emotional reactions after a MI should be monitored during convalescence to identify patients at risk for a failure in emotional readjustment. Furthermore, effective treatment of initial emotional reactions could promote resumption of work and reduce long-term morbidity.

Anxiety is commonly experienced by patients following myocardial infarction. The role of anxiety in the recovery/rehabilitation process is not well understood, but anxiety is thought to be one of the factors determining outcome. It is important, therefore, to understand the possible effects on anxiety of changing discharge policies in coronary care units. Anxiety was assessed in a sample of MI patients, with good or poor prognoses, assigned to either early or late discharge from a coronary care unit. Although the overall level of anxiety of the total sample was not unduly high, it was clear that there was a subgroup of individuals, high in trait anxiety and with a poor prognosis, for whom early discharge was contra-indicated. Irrespective of prognosis, it was clear that early discharge did not produce a uniform response, indicating the need to differentiate between patients when determining the optimal date for discharge.