Dept of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Dept. of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin, Campus Benjamin Franklin, Berlin, Germany.
Dept. of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin, Campus Benjamin Franklin, Berlin, Germany.
J Psychosom Res. 2018 Feb;105:125-131. doi: 10.1016/j.jpsychores.2017.12.005. Epub 2017 Dec 5.
Low socio-economic status (SES) has been associated with an increased coronary risk in Western countries. All stress experiences are more pronounced in low SES patients with stress emanating from problems with family, job, or money. The SPIRR-CAD study offered an excellent opportunity to examine these risk factors in German speaking mildly and medium depressed patients. In the SPIRR CAD study, a German multi centre randomized clinical trial of 450 male and 120 female coronary patients, we examined the standard and psychosocial risk factor profiles in relation to SES, as assessed by educational level. All differences in risk factors between low and high SES were in the inverse direction. Of standard risk factors, only smoking was socially graded and more common in low SES. Of psychosocial factors and emotions, exhaustion showed the strongest and most consistent inverse social gradient, but also anger, anxiety and depression were socially graded. The findings suggest that in German patients, as in other national groups, social gradients in CHD risk are considerable. They can be ascribed to both psychosocial and to standard risk factors. In the present two years follow-up, the prospective significance of psychological and social risk factors was analyzed showing that emotional factors played an important role, in that low and high SES patients differed in the expected direction. However, the differences were not statistically significant and therefore firm conclusions from follow up were not possible.
ISRCTN 76240576; NCT00705965.
低社会经济地位（SES）与西方国家的冠心病风险增加有关。所有的压力体验在 SES 较低的患者中更为明显，这些压力源自家庭、工作或金钱问题。SPIRR-CAD 研究为研究德国轻度和中度抑郁冠心病患者的这些风险因素提供了极好的机会。在 SPIRR CAD 研究中，这是一项德国多中心随机临床试验，纳入了 450 名男性和 120 名女性冠心病患者，我们根据受教育程度评估了 SES 与标准和社会心理风险因素谱之间的关系。SES 较低和较高的患者之间所有风险因素的差异均呈反向。在标准风险因素中，只有吸烟具有社会等级性，且 SES 较低的患者中更为常见。在社会心理因素和情绪方面，精疲力竭表现出最强和最一致的反向社会梯度，但愤怒、焦虑和抑郁也具有社会等级性。研究结果表明，在德国患者中，与其他国家群体一样，CHD 风险的社会梯度相当大。这些风险可归因于社会心理和标准风险因素。在目前为期两年的随访中，分析了心理和社会风险因素的前瞻性意义，结果表明情绪因素起着重要作用，因为 SES 较低和较高的患者在预期方向上存在差异。然而，差异无统计学意义，因此无法从随访中得出明确的结论。
ISRCTN 76240576；NCT00705965。
