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Socioeconomic status, cognitive-emotional factors, and health status following myocardial infarction: testing the Reserve Capacity Model

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Abstract

Health disparities by socioeconomic status (SES) exist for many outcomes, including patients’ subjective health status after myocardial infarction (MI). The Reserve Capacity Model (RCM), a theoretical means to understand such disparities, was tested to examine the possible mediating effects of cognitive-emotional factors on the association between SES and health status. Data from 2,348 post-MI patients in PREMIER were used. Indicators of SES were collected during hospitalization via personal interviews, while participants completed measures of stress and reserves at 1 month, depressive symptoms at 6 months, and health status at 1 year through telephone interviews. Structural equation model results provide partial support for the RCM, as cognitive-emotional factors partially mediated the association between SES and mental health status. For physical health status, results supported direct rather than indirect effects of SES. Findings suggest psychosocial interventions with patients of low SES will have their greatest effects on appraisals of psychological health status.

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Notes

  1. Previous studies using PREMIER have found dyspnea to be cross-sectionally associated with similar outcomes, so an exploratory structural model with it as a baseline covariate was estimated. In this exploratory analysis, model fit changed only minimally (RMSEA = .04 vs .04; CFI = .95 vs. .94; NNFI = .89 vs. .88), no path coefficient changed by more than ±.006, and in no case did statistical significance change.

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Acknowledgments

This research was supported by: (1) CV Therapeutics, Inc. of Palo Alto, CA, (2) CV Outcomes, Inc. of Kansas City, MO, and (3) the University of Missouri–Kansas City Department of Psychology.

Conflict of interest

Kymberley K. Bennett, Donna M. Buchanan, and Philip G. Jones declare that they have no conflict of interest. John A. Spertus developed and owns the copyright for the Seattle Angina Questionnaire.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Psychology, University of Missouri–Kansas City, Cherry Hall, Room 302, Kansas City, MO, 64110, USA

    Kymberley K. Bennett

  2. Department of Biomedical and Health Informatics, Saint Luke’s Mid-America Heart Institute, University of Missouri–Kansas City, Kansas City, MO, USA

    Donna M. Buchanan

  3. BLANK, Saint Luke’s Mid-America Heart Institute, Kansas City, MO, USA

    Philip G. Jones

  4. Departments of Internal Medicine and Biomedical and Health Informatics, Saint Luke’s Mid-America Heart Institute, University of Missouri–Kansas City, Kansas City, MO, USA

    John A. Spertus

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  1. Kymberley K. Bennett
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Correspondence to Kymberley K. Bennett.

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Bennett, K.K., Buchanan, D.M., Jones, P.G. et al. Socioeconomic status, cognitive-emotional factors, and health status following myocardial infarction: testing the Reserve Capacity Model. J Behav Med 38, 110–121 (2015). https://doi.org/10.1007/s10865-014-9583-4

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  • DOI: https://doi.org/10.1007/s10865-014-9583-4

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