Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years.

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.