Siegrist J, Dittmann K, Rittner K, Weber I
Soc Sci Med. 1982;16(4):443-53. doi: 10.1016/0277-9536(82)90052-1.
Data of a retrospective case control study on 380 male patients with clinically documented first myocardial infarction (MI) (age 30-55) as well as findings of a follow-up over 18 months of 70% of this sample are presented. Results show first, that specific work stressors, lack of social support, and acute life changes are each significantly more prevalent among subjects with MI than among healthy controls; second, that significantly greater parts of MI subjects can be classified as simultaneously exposed to several chronic and acute social risks; third, that social stressors are related to the recurrence of cardiac symptoms in a follow-up after rehabilitation. These findings are discussed with regard to possible methodological bias such as the role of denial and neuroticism in patients under study, influences caused by interviewers, and limited validity of subjective stress rating. After controlling for these biases, findings basically remain stable. It is argued that a certain class of critical socio-emotional experiences, labeled 'active distress' may be harmful to neurohormonal imbalance, and, consequently, to several precursors of cardiovascular diseases. This class of experiences is reinforced and sustained by social contexts as the ones investigated in this study.
本文呈现了一项针对380名临床诊断为首次心肌梗死（MI）的男性患者（年龄在30至55岁之间）的回顾性病例对照研究数据，以及对该样本中70%患者进行的18个月随访结果。结果显示，第一，特定的工作压力源、缺乏社会支持和急性生活变化在MI患者中比在健康对照组中更为普遍；第二，相当大比例的MI患者可被归类为同时面临多种慢性和急性社会风险；第三，社会压力源与康复后随访期间心脏症状的复发有关。针对可能的方法学偏差，如研究中患者否认和神经质的作用、访谈者造成的影响以及主观压力评分的有限有效性，对这些发现进行了讨论。在控制这些偏差后，研究结果基本保持稳定。研究认为，一类被称为“主动困扰”的关键社会情感体验可能对神经激素失衡有害，进而对心血管疾病的多种先兆产生影响。这类体验会因社会环境而强化和持续，本研究中所调查的社会环境就是如此。
