Psychological factors and return to work.

Return to work is considered to be a criterion of a good outcome after a myocardial infarction or coronary revascularisation procedure. In general, return to work is not necessarily correlated with cardiac state; a variety of psychological, social and economic factors influence whether or not the individual will return to gainful employment. Psychological variables to be considered include the reactions of patient and family, their understanding of the illness, the personality and behavioural characteristics of the patient, expectations of the results of treatment and attitudes towards disability. These will be influenced by aspects of the job itself or the working environment as perceived by the patient. Physicians' attitudes are strong factors in influencing the final decision on whether or not the patient goes back to work. Employers and fellow employees, by their attitudes to the illness, will also influence the decisions. It follows that assessment and management of psychological problems must be part of total patient care after a coronary event if the optimal number of patients are to return to work, confidence of their ability to cope with its demands. Though the actual way in which assessment is made and appropriate treatment undertaken may vary considerably, a study of available knowledge enables general guidelines on these aspects to be given.