Support, stress, and recovery from coronary heart disease: a longitudinal causal model.

Measures of support, stress, distress, and cardiac symptoms were obtained from a cohort of 73 male cardiac patients at hospitalization and at 3, 6, and 12 months thereafter. Sets of general and alternative hypotheses regarding the direction of causality among these variables were drawn from the literature on cardiac rehabilitation, stress, and support. Structural equation modeling was used to evaluate the stability and duration of these hypotheses over three time-lags. The results showed strong support for the general hypotheses and minimal support for the alternative hypotheses. Support ameliorated the subsequent experience of stress and distress and had opposing effects to these variables on cardiac symptoms. Support was more influential in the first half of the year than it was in the second half, however, whereas stress was predominant causally in the second half. Implications of this pattern for clinical intervention are drawn and directions for further research are proposed.