Adaptive behavior in stressful situations in relation to postinfarction mortality results from prospective cohort study ‘men born in 1914’ in malmö, Sweden

  • Lena André-PeterssonEmail author
  • Bo Hagberg
  • Lars Janzon
  • Gunilla Steen


The serial Color Word Test, which is a semi-experimental way to differentiate adaptive behavior in stressful situations, was administered at baseline to men participating in the prospective cohort study ‘Men born in 1914’. During follow-up, from 1982-1983 until December 31, 1996, 133 men experienced a myocardial infarction. Four patterns of adaptive behavior in 2 separate dimensions, the Variability and the Regression, can be discerned during testing. These patterns were compared regarding outcome following the myocardial infarction. The Cumulative-dissociative pattern of the Regression dimension was univariately associated with mortality within 28 days (OR 5.75, CI 1.85-17.88, p = .003). Dissociative (OR 3.87, CI 1.21-12.42, p = .023) and Cumulative-dissociative (OR 5.46, CI 1.66-17.96, p= .005) patterns, of the same dimension, were independently associated with mortality within one year. Specific difficulties in adaptation to stressful situations were associated with increased risk of death following a myocardial infarction. In this male sample, these difficulties could be identified with the serial Color Word Test.

Key words

adaptive behavior stress mortality myocardial infarction Color Word Test 


  1. André-Petersson, L., Hagberg, B., Hedblad, B., Janzon, L., & Steen, G. (1999). Incidence of cardiac events in hypertensive men related to adaptive behavior in stressful encounters.International Journal of Behavioral Medicine, 6, 331–355.PubMedCrossRefGoogle Scholar
  2. André-Petersson, L., Engström, G., Hagberg, B. Janzon, L., & Steen, G. (2001). Adaptive behavior in stressful situations and stroke incidence in hypertensive men. Results from prospective cohort study ‘Men born in 1914’ in Malmö, Sweden.Stroke, 32, 1712–1717.PubMedGoogle Scholar
  3. Barnett, P. A., Spence, J. D., Manuck, S. B., & Jennings, J. R. (1996). Psychological stress and the progression of carotid artery disease.Journal of Hypertension, 15, 49–55.CrossRefGoogle Scholar
  4. Denollet, J., & De Potter, B. (1992). Coping subtypes for men with coronary heart disease: Relationship to well-being, stress and Type-A behavior.Psychological Medicine, 22, 667–684.PubMedCrossRefGoogle Scholar
  5. Denollet, J., Stanislas, U. S., & Brutsaert, D. L. (1995). Personality and mortality after myocardial infarction.Psychosomatic Medicine, 57, 582–591.PubMedGoogle Scholar
  6. Denollet, J., Stanislas, U. S., Stroobant, N., Rombouts, H., Gillebert, T. C., & Brutsaert, D. L. (1996). Personality as independent predictor of long-term mortality in patients with coronary heart disease.The Lancet, 347, 417–421.CrossRefGoogle Scholar
  7. Doehrman, S., Landau, R., & O’Connell, D. (1978). The Stroop phenomenon: Perceptual conflict or response competition?Perceptual and Motor Skills, 47, 1127–1131.PubMedGoogle Scholar
  8. Eberhard, G., & Ljunghill-Andersson, J. (1968). Results of experimental part of the main investigation.Acta Psychiatrica Scandinavica, (Suppl. 205), 46-54.Google Scholar
  9. Eliot, S., & Morales-Ballejo, H. M. (1994). The heart, emotional stress, and psychiatric disorders. In R. C. Schlant & R. W. Alexander (Eds.),The heart. Arteries and veins (8th ed., pp. 2087–2097). New York: McGraw-Hill.Google Scholar
  10. Everson, S. A., Kaplan, G. D., Goldberg, D. E., & Salonen, J. T. (1996). Anticipatory blood pressure response to exercise predicts future high blood pressure in middle-aged men.Hypertension, 27, 1059–1064.PubMedGoogle Scholar
  11. Hansen, O., & Johansson, B. W. (1991). Epidemiologic aspects of coronary heart disease in Malmö, Sweden 1935-88.American Journal of Epidemiology, 133, 721–733.PubMedGoogle Scholar
  12. Hemingway, H., & Marmot, M. (1999). Evidence based cardiology. Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies.British Medical Journal, 318, 460–467.Google Scholar
  13. Janzon, L., Hanson, B. S., Isacsson, S. O., Lindell, S. E., & Steen, B. (1986). Factors influencing participation in health surveys. Results from prospective population study ‘Men born in 1914‘ in Malmö, Sweden.Journal of Epidemiology and Community Health, 40, 174–177.PubMedCrossRefGoogle Scholar
  14. Jennings, J. R., Kamarck, T., Manuck, S., Everson, S. A., Kaplan, G., & Salonen, J. T. (1997). Aging or disease? Cardiovascular reactivity in Finnish men over the middle years.Psychology and Aging, 12, 225–238.PubMedCrossRefGoogle Scholar
  15. Kamarck, T. W., Everson, S. A., Kaplan, G. A., Manuck, S. B., Jennings, J. R., & Salonen, R., et al. (1997). Exaggerated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men.Circulation, 96, 3842–3848.PubMedGoogle Scholar
  16. Kamarck, T. W., Jennings, J. R., Pogue-Geile, M., & Manuck, S. B. (1994). A multidimensional measurement model for cardiovascular reactivity: Stability and cross-validation in two adult samples.Health Psychology, 13, 471–478.PubMedCrossRefGoogle Scholar
  17. Kragh, U., & Smith, G. J. W. (1970).Percept-genetic analysis. Lund, Sweden: Gleerups.Google Scholar
  18. Lezak, M. D. (1995).Neuropsychological assessment (3rd ed.). New York: Oxford University Press.Google Scholar
  19. Manuck, S. B. (1994). Cardiovascular reactivity in cardiovascular disease; ‘Once more unto the breach.’International Journal of Behavioral Medicine, 1, 4–31.PubMedCrossRefGoogle Scholar
  20. Markowitz, J. H., Raczynski, J. M., Chettur, V., & Chesney, M. (1998). Cardiovascular reactivity to video game predicts subsequent blood pressure increases in young men: The CARDIA Study.Psychosomatic Medicine, 60, 186–191.Google Scholar
  21. Rose, G. A., & Blackburn, H. (1968). Cardiovascular survey methods.World Health Organization Monographs, 56, 1–188.Google Scholar
  22. Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.Circulation, 99, 2192–2217.PubMedGoogle Scholar
  23. Rubino, I. A., Verucci, M., & Fortuna, E. (1993). Micro-genetic styles of regulation among two nonpsychotic psychiatric groups.Perceptual and Motor Skills, 76, 1059–1069.PubMedGoogle Scholar
  24. Smith, G. J. W., Nyman, G. E., & Hentschel, U. (1986).Manual till CWT—Serialt färgordtest [Manual to CWT — Serial color word test (S-CWT)]. Stockholm, Sweden: Psykologiförlaget AB.Google Scholar
  25. Smith, G. J. W., Nyman, G. E., Hentschel, U., & Rubino, I. A. (in press).The serial Color-Word Test (s-CWT). Leyden, The Netherlands: Swets & Zeitlinger.Google Scholar
  26. Steen, G., Hagberg, B., Johnson, G., & Steen, B. (1987). Cognitive function, cognitive style and life satisfaction in a 68-year-old male population.Comprehensive Gerontology B, 1, 54–61.Google Scholar
  27. Stroop, J. R. (1935). Studies of interference in serial verbal reactions.Journal of Experimental Psychology, 18, 643–662.CrossRefGoogle Scholar
  28. Vita, J. A., Ganz, P., & Selwyn, A. P. (1991). Interactions between mental stress and coronary heart disease. In A. P. Shapiro & A. Baum (Eds.),Behavioral aspects of cardiovascular disease (pp. 3–9). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  29. World Health Organization. (1977).International Classification of Diseases, Ninth Revision (ICD-9). Geneva, Switzerland: Author.Google Scholar
  30. Ögren, M., Hedblad, B., Isacsson, S.-O., Janzon, L., Jungqvist, G., & Lindell, S.-E. (1995). Ten year cerebrovascular morbidity and mortality in 68 year old men with asymptomatic carotid stenosis.British Medical Journal, 310, 1294–1298.PubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2003

Authors and Affiliations

  • Lena André-Petersson
    • 1
    Email author
  • Bo Hagberg
    • 2
  • Lars Janzon
    • 3
  • Gunilla Steen
    • 4
  1. 1.Department of Community MedicineMalmö University HospitalMalmöSweden
  2. 2.Gerontology Research Center, LundSweden
  3. 3.Division of Epidemiology, Department of Community MedicineMalmö University HospitalSweden
  4. 4.Department of Geriatric MedicineGöteborg UniversitySweden

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