The course and determinants of reactions to myocardial infarction.

The growth of speculative theories about response to physical illness has not been backed by quantitative information. The introduction of standardized measures of psychological and social adjustment has allowed description and analysis of disability for 100 patients and their spouses two and twelve months after a first myocardial infarction. (1) Global measures of social outcome were found to be inadequate and misleading and therefore work, leisure, marriage and family relationships, sex and compliance were separately examined. (2) There was considerable continuity in individual reactions throughout convalescence and it was possible (3) to identify factors in the premorbid psychosocial state predictive of outcome and (4) to describe characteristic patterns of coping. (5) Outcome for spouses can be similarly described and understood. The findings have clinical applications for diagnosis, prophylaxis, treatment and the evaluation of medical care. The conclusion also extend our understanding of the basic principles underlying response to physical illness.