The social context of active distress in patients with early myocardial infarction.

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.