From Clinical Experience to Tested Hypothesis: The Role of Psychosocial Factors in Coronary Heart Disease

  • J. J. Groen


The influence of psychosocial factors in the development of coronary heart disease has been suspected for many years by family practitioners and physicians like William Osier. The clinical impression that myocardial infarction preferably strikes a certain type of person and frequently occurs after a shattering life event was supported by more systematic clinical observations made from 1935 to 1955, although these observations lacked the support of control groups (Arlow 1945; Dunbar 1943; Dreyfuss 1959; Gildea 1949; Russek and Zohman 1958; Raab 1964). Our first systematic studies took place between 1956 and 1965 and were based on long biographies of 24 successive male, married patients (Groen et al. 1965; 1968 a) who were admitted to the Wilhelmina Gasthuis in Amsterdam. Psychosocial factors were found to precede the onset of disease in all of the patients. Based on these systematic clinical observations, we formulated the hypothesis (Van der Valk et al. 1967) that myocardial infarction seems to occur as a result of a constellation of three factors:
  1. 1.

    Certain personality characteristics determined by heredity, maturation, and previous experiences), which seem to predispose certain individuals more than others to become involved in

  2. 2.

    a certain type of interhuman conflict situation, which serves as a more immediately precipitating “stressor”

  3. 3.

    certain types of behavior through which the individual, because of his personality, responds to this conflict.



Coronary Heart Disease Angina Pectoris Psychosocial Factor Financial Problem Family Problem 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Arlow JA (1945) Identification mechanisms in coronary occlusion. Psychosom Med 7: 195Google Scholar
  2. Dreyfuss F (1959) Role of emotional stress preceding coronary occlusion. Am J Cardiol 3: 590PubMedCrossRefGoogle Scholar
  3. Dunbar F (1943) Psychosomatic Diagnosis. Hoeber, New YorkGoogle Scholar
  4. Gildea A (1949) Special features of personality which are common to certain psychosomatic disorders. Psychosom Med 11: 273PubMedGoogle Scholar
  5. Raab W (ed) (1964) Prevention of ischaemic heart disease. Thomas, Springfield, 111.Google Scholar
  6. Russek HI, Zohman BL (1958) Relative significance of heredity, diet and occupational stress in coronary heart disease of young adults. Am J Med Sei 235: 266CrossRefGoogle Scholar
  7. Groen JJ (1976) Psychosomatic aspects of ischaemic (coronary) heart disease. In: HillOW (ed)Google Scholar
  8. Modern trends in psychosomatic medicine, vol 3. Butterworths, London, pp 288Google Scholar
  9. Groen JJ, Drory S (1967) Influence of psychosocial factors on coronary heart disease: a comparison of autopsy findings with the results of a sociological questionnaire. Pathol Microbiol 30: 779Google Scholar
  10. Groen JJ, van der Valk JM, Treurniet N, Kits van Heyningen H, PelserHE, Wilde GJS (1965) Hetacute myocardinfarct, een psychosomatische Studie. Bohn, HaarlemGoogle Scholar
  11. Groen JJ, van der Valk JM, Treurniet N, Kits van Heyningen H, Pelser HE, Wilde GJS (1968 a) Psychological factors in the causation of myocardial infarction. In: Psychotropic drugs in internal medicine: an international symposium. Excerpta Medica, Amsterdam, p 199Google Scholar
  12. Groen JJ, Dreyfuss F, GutmanL (1968 b) Epidemiological, nutritional and sociological studies of atherosclerotic (coronary) heart disease among different ethnic groups in Israel, In: Miras CJ, Howard AN, PaolettiR (eds) Progress in Biochemical Pharmacology: Recent Advances in Atherosclerosis, vol 4, p 230Google Scholar
  13. Groen JJ, Medalie JH, Neufeld H, Ris E (1968 c) An epidemiological investigation of hypertension and ischaemic heart disease in Israel. Isr J Med Sei 4: 775Google Scholar
  14. Medalie JH, Kahn HA, Groen JJ et al. (1968) The prevalence of ischaemic heart disease in relation to selected variables. Isr J Med Sci 4: 789PubMedGoogle Scholar
  15. Medalie JH, Kahn HA, Neufeld HN, Riss E, Groen JJ, Goldbourt U (1973 a) Five-year myocardial infarction incidence: associations of single variables to age and birthplace. J Chronic Dis 26: 329Google Scholar
  16. Medalie JH, Snijder M, Groen JJ, Neufeld H, Ris E, Goldbourt U (1973 b) Angina pectoris among 10000 men, 5-year incidence and univariate analysis. Am J Med 55: 583Google Scholar
  17. Mine S (1960) The civilized pattern of human activity and coronary heart disease. Med J Aus 2: 87Google Scholar
  18. Mine S (1963) Some psychological factors in coronary heart disease. Psychosom Med 25: 133Google Scholar
  19. Mine S (1967) Emotions and ischaemic heart disease. Am Heart J 73: 713CrossRefGoogle Scholar
  20. Van der Valk JM, Groen JJ (1967) Personality structure and conflict situations in patients with myocardial infarction. J Psychosom Res 11: 41PubMedCrossRefGoogle Scholar
  21. Wolf S (1966) Mortality from myocardial infarction in Roseto. JAMA 195:142 WolfS (1969) Psychosocial forces in myocardial infarction and sudden death. Circulation 39-40 [Suppl 4]: 74Google Scholar
  22. Wolf S (ed) (1971) The artery and the process of arteriosclerosis. Plenum, New YorkGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • J. J. Groen
    • 1
    • 2
  1. 1.Hebrew UniversityJerusalemIsrael
  2. 2.Department KNO, Academic HospitalUniversity of LeidenLeidenThe Netherlands

Personalised recommendations