Hostility, Depression, Social Environment and CHD Risk

BACKGROUND:

Hostility, depression/depressive personality, and socioeconomic status (SES) have all been shown to influence the risk of coronary heart disease (CHD). While the three factors have been studied separately in previous work, there is evidence that they are interrelated and there is reason to hypothesize that they would interact in a multiplicative fashion to dramatically increase risk when they are present in combination.

DESIGN NARRATIVE:

Three studies were conducted designed to describe the interrelationships of hostility, depression/depressive personality, and socioeconomic status and document their joint impact on several health outcomes. Study 1 took advantage of two existing databases to study over 3000 coronary artery disease patients who had been followed for over a decade. Both self-report and behavioral indicators of hostility and depression were studied in combination with SES to predict survival while controlling for initial disease severity. These measures were also used in analyses designed to discriminate the psychosocial profile of patients who died early in follow-up from those who died after five years. Data on health behavior profiles and medical care utilization were examined to evaluate the possibility that those factors could account for the relationships between psychosocial characteristics and survival.

Study 2 examined the ability of depressive personality, hostility, and SES to jointly predict acute myocardial infarction (AMI) and mortality in a sample of 730 initially healthy people who had been followed for 30 years. It also investigated the associations of these psychosocial measures with changes in risk factor patterns and health indicators over the follow-up period.