A bstract T his study compared the relative ef® cacy of two different rehabilitation programm es (one with and one without the Edinburgh H eart M anual) on psychosoc ial outcom e following a ® rst m yocardial infarction (M I).A six-m onth longitudinal design was used to assess changes in the following variables: locus of control, signi® cant other sup port, illness perceptions, anxiety, depression and generalized self-ef® cacy. T hese variables were also used to predict general practitioner (G P) contact and hospital adm issions in the six m onths following the M I. Patients receiving the manual (N 5 45) reported stronger beliefs in their ability to control the illness (p , 0.05) and less depression (p , 0.01) at follow -up, compared w ith patients receiving a hosp ital-based exercise and education programme (N 5 25). There was no signi® cant difference between the two groups on GP contact and hospital admissions in the six months after the M I. Baseline anxiety predicted GP contact in the six m onths post-M I (p , 0.001).
Introdu ctionSigni® cant advan ces in m edical and pharm acological interventions have resulted in im proved survival and fewer com plications for post-M I patients. Num erous studies have been concerned with survival after M I, but far less is know n abo ut m orbidity and illness-related behaviour in post-M I patients. It has long been observed that patients' recovery following M I has been less com plete than would have been expected based solely on their ph ysical condition (W H O , 1964). M ore recently, research has focused on psycho social factors as potential predictors of outcom e following illness.The beliefs and attribu tions that people hold can in¯uence their health, either directly, by in¯uencing a physio logical system such as the imm une system , or indirectly, by affecting their behaviour such as the food they eat or whether they seek m edical help when they feel ill. M any different beliefs and attribu tions have been considered as precursors to health-related behaviour but there is a lack of consensus on which ones are m ost importan t. Locus of control, with its origins in social learning theory, has been extensively studied and the m ere A ddress for correspondence: Dr A Â ine O' R ourke, H artlepool and East Durham Trust, M edical D irectorate, H oldforth R oad, H artlepool TS24 9AH, UK. Tel: 1 44 01429 522417; Fax: 1 44 01429 869852.
there is a need to address the problems of anxiety and depression directly by screening and treatment, and to provide more psychologically-orientated cardiac rehabilitation programmes.
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