Psychosocial Aspects of Chronic Illness: Direct and Indirect Associations with Ischemic Heart Disease Mortality

  • George A. Kaplan
Part of the NATO ASI Series book series (NSSA, volume 84)


Every aspect of human health and disease bears the imprint of psychosocial processes. Although this is a rather strongly worded statement, it can, I believe, stand up to the hardest scrutiny at both empirical and conceptual levels. The facts leading to this conclusion have been stated by many. Psychosocial factors are related to exposure to harmful agents or environments, to the practice of risk-increasing or decreasing behaviors, to increased susceptibility to particular conditions, progression of disease, help-seeking behavior, access to medical care, adherence to and effect of medical treatments, recovery from serious conditions, and a wide range of other outcomes. Although the quality of the evidence varies widely, the variety of methodologies and endpoints considered in the literature lends confidence to my first statement.


Coronary Heart Disease Life Satisfaction Ischemic Heart Disease Health Practice Blood Lead Level 


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  1. Ader, R. A. (ed.) Psychoneuroimmunology. New York: Academic Press, 1981.Google Scholar
  2. Antonovsky, A. Health, stress, and coping. San Francisco: Josey-Bass Publishers, 1979.Google Scholar
  3. Antonovsky, A. Social class and the major cardiovascular diseases. Journal of Chronic Diseases 21 (1968) 65–106.PubMedCrossRefGoogle Scholar
  4. Bandura, A. Self-efficacy mechanism in human agency. American Psychologist 37 (1982) 122–147.CrossRefGoogle Scholar
  5. Belloc, N. B. Relationship of health practices and mortality. Preventive Medicine 2 (1973) 67–81.PubMedCrossRefGoogle Scholar
  6. Belloc, N. B. and Breslow, L. Relationship of physical health status and health practices. Preventive Medicine 1 (1972) 409–421.PubMedCrossRefGoogle Scholar
  7. Berkman, L. F. Social networks, host resistance, and mortality: A follow-up study of Alameda County residents. Ph.D. Dissertation, University of California, Berkeley, 1977.Google Scholar
  8. Berkman, P. L. Spouseless motherhood, psychological stress, and physical morbidity. Journal of Health and Social Behavior 10 (1969) 323–334.PubMedCrossRefGoogle Scholar
  9. Berkman, L. F. and Breslow, L. Health and ways of living. New York: Oxford, 1983.Google Scholar
  10. Berkman, L. F. and Syme, S. L. Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology 109 (1979) 186–204.PubMedGoogle Scholar
  11. Blazer, D. G. Social support and mortality in an elderly community population. American Journal of Epidemiology 115 (1982) 684–694.PubMedGoogle Scholar
  12. Breslow, L. and Enstrom, J. E. Persistence of health habits and their relationship to mortality. Preventive Medicine 9 (1980) 469–483.PubMedCrossRefGoogle Scholar
  13. Cassel, J. The contribution of the social environment to host resistance. American Journal of Epidemiology 104 (1976) 107–123.PubMedGoogle Scholar
  14. Cassel, J., Heyden, S., and Bartel, G. Incidence of coronary heart disease by ethnic group, social class and sex. Archives of Internal Medicine 128 (1971) 901–906.PubMedCrossRefGoogle Scholar
  15. Chandra, V., Szklo, M., Goldberg, R., and Tonascia, J. The impact of marital status on survival after an acute myocardial infarction: A population-based study. American Journal of Epidemiology 117 (1983) 320–325.PubMedGoogle Scholar
  16. Cottington, E. M., Matthews, K. A., Talbott, E., and Kuller, L. H. Environmental events preceding sudden death in women. Psychosomatic Medicine 4 (1980) 567–574.Google Scholar
  17. Cowie, B. The cardiac patient’s perception of his heart attack. Social Science and Medicine 10 (1976) 87–96.CrossRefGoogle Scholar
  18. Cummings, K. M., Becker, M. H., and Maile, M. C. Bringing the models together: An empirical approach to combining variables used to explain health actions. Journal of Behavioral Medicine 3 (1980) 13–145.Google Scholar
  19. Garber, J. and Seligman, M. E. P. Human helplessness. New York: Academic Press, 1980.Google Scholar
  20. Glass, D. C. Behavior patterns, stress, and coronary disease. New York: Wiley, 1977.Google Scholar
  21. Helsing, K. J. and Szklo, M. Mortality after bereavement. American Journal of Epidemiology 114 (1981) 41–52.PubMedGoogle Scholar
  22. Henry, J. P. The relation of social to biological processes in disease. Social Science and Medicine 16 (1982) 369–380.PubMedCrossRefGoogle Scholar
  23. Hochstim, J. R. Health and ways of living—the Alameda County, California, population laboratory. In Kesler, I. I., and Levin, M. L. (eds.) The community as an epidemiologic laboratory. Baltimore: Johns Hopkins University Press, 1970.Google Scholar
  24. Holme, I., Helgeland, A., Hjermann, I., Leren, P., and Lund-Larsen, P. G. Four-year mortality by some socioeconomic indicators: The Oslo Study. Journal of Epidemiology and Community health 34 (1980) 48–52.PubMedCrossRefGoogle Scholar
  25. House, J. S., Robbins, C., and Metzner, H. L. The association of social relationships and activities with mortality: Prospective evidence from the Tecumseh Community Health Study. American Journal of Epidemiology 116 (1982) 123–140.PubMedGoogle Scholar
  26. Inkeles, A. and Smith, D. H. Becoming modern: Individual change in six developing countries. Cambridge: Harvard University Press, 1974.Google Scholar
  27. Jenkins, C. D. Recent evidence supporting psychologic and social risk factors for coronary disease. New England Journal of Medicine 294 (1976) 987–994, 1034–1038.Google Scholar
  28. Jenkins, C. D. Psychologic and social precursors of coronary disease. New England Journal of Medicine 284 (1971) 244–255, 207–317.Google Scholar
  29. Kaplan, G. A. Understanding the understanding of heart attack: Patient and physician perspectives. Paper presented at the American Psychological Association Meetings, Los Angeles, September, 1981.Google Scholar
  30. Kaplan, G. A. and Camacho, T. Perceived health and mortality: Nine-year follow-up of the Human Population Laboratory cohort. American Journal of Epidemiology 117 (1983) 292–304.PubMedGoogle Scholar
  31. Karasek, R. A., Baker, D., Marxer, F., Ahlbom, A., and Theorell, T. Job decision latitude, job demands and cardiovascular disease: A prospective study of Swedish men. American Journal of Public Health 71 (1981) 694–705.PubMedCrossRefGoogle Scholar
  32. Karasek, R. A., Theorell, T., Schwartz, J., Peiper, C., and Alfredsson, L. Job, psychological factors and coronary heart disease. Advances in Cardiology 29 (1982) 62–67.PubMedGoogle Scholar
  33. Kobasa, S. C. The hardy personality. In Sanders, G. S., and Suls, J. (eds.) Social psychology of health and illness. Hillsdale, N.J.: Lawrence Erlbaum Associates, 1982.Google Scholar
  34. Koskenvuo, M., Kaprio, J., Romo, M., and Langinvaino, H. Incidence and prognosis of ischemic heart disease with respect to marital status and social class: A national record linkage study. Journal of Epidemiology and Community Health 35 (1981) 192–196.PubMedCrossRefGoogle Scholar
  35. Langer, E. J. The illusion of control. Journa of Personality and Psychology 32 (1975) 311–328.CrossRefGoogle Scholar
  36. Mahaffey, K. R., Annest, J. L., Roberts, J., and Murphy, R. S. National estimates of blood lead levels: United States, 1976–1980. Association with selected demographic and socioeconomic factors. New England Journal of Medicine 307 (1982) 573–579.PubMedCrossRefGoogle Scholar
  37. Marmot, M. G. and Syme, S. L. Acculturation and coronary heart disease in Japanese-Americans. American Journal of Epidemiology 104 (1976) 225–247.PubMedGoogle Scholar
  38. Morgenstern, H. The changing association between social status and coronary heart disease in a rural population. Social Science and Medicine 14 (1980) 191–201.Google Scholar
  39. Mossey, J. M. and Shapiro, E. Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health 72 (1982) 800–808.PubMedCrossRefGoogle Scholar
  40. Reed, D., McGee, D., Yano, K., and Feinleib, M. Social networks and coronary heart disease among Japanese men in Hawaii. American Journal of Epidemiology 117 (1983) 384–396.PubMedGoogle Scholar
  41. Renne, K. S. Measurement of social health in a general population survey. Social Science Research 3 (1974) 25–44.CrossRefGoogle Scholar
  42. Roberts,. Prevalence of depressive symptoms among Mexican Americans. Journal of Mental and Nervous Disorders 169 (1981) 213–219.CrossRefGoogle Scholar
  43. Rose, G. and Marmot, M. G. Social class and coronary heart disease. British Heart Journal 45 (1981) 13–19.PubMedCrossRefGoogle Scholar
  44. Salonen, J. T. Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: A longitudinal study in eastern Finland. Journal of Epidemiology and Community Health 36 (1982) 294–297.PubMedCrossRefGoogle Scholar
  45. Satariano, W. and Syme, S. L. Life change and illness in the elderly: Coping with change. Paper presented at the National Academy of Sciences Conference on Biology and Behavior, Woods Holes, Mass., June 22–24, 1979.Google Scholar
  46. Scherwitz, L., McKelvain, R., Laman, C., Patterson, J., Dutton, L., Yusim, S., Lester, J., Kraft, I., Rochelle, D., and Leachman, R. Type A behavior, self-involvement, and coronary atheroslcerosis. Psychosomatic Medicine 45 (1983) 47–57.PubMedGoogle Scholar
  47. Shekelle, R. B., Gale, M., Ostfeld, A., and Paul, O. Hostility, risk of coronary heart disease, and mortality. Psychosomatic Medicine 45 (1983) 109–114.PubMedGoogle Scholar
  48. Thoits, P. Conceptual, methodological, and theoretical problems in studying support as a buffer against life stress. Journal of Health and Social Behavior 23 (1982) 145–159.PubMedCrossRefGoogle Scholar
  49. Wiley, J. A. and Camacho, T. C. Life-style and future health: Evidence from the Alameda county Study. Preventive Medicine 9 (1980) 1–21.PubMedCrossRefGoogle Scholar
  50. Williams, R. B., Haney, T. L., Lee, K. L., Kong, Y., Blumenthal, J. A., and Whalen, R. E. Type A behavior, hostility and coronary atherosclerosis. Psychosomatic Medicine 42 (1980) 539–549.PubMedGoogle Scholar
  51. Wingard, D. L. The sex differential in mortality rates: Biological and social factors. Ph.D. Dissertation, University of California, Berkeley, 1980.Google Scholar
  52. Wingard, D. L., Berkman, L. F., and Brand, R. J. A multivariate analysis of health-related practices: A nine-year mortality follow-up of the Alameda County Study. American Journal of Epidemiology 116 (1982) 767–775.Google Scholar

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© Plenum Press, New York 1985

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  • George A. Kaplan

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