Socioeconomic Differences in Psychosocial Factors Contributing to Coronary Heart Disease: A Review

Abstract

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.

Inequalities in therapeutic treatment during cardiac inpatient rehabilitation in Germany

“…Patients of low SES, on the other hand, might be less likely to express their expectations in the medical encounter, less likely to voice desires and, if they do, more likely to say that they want to relax and not be burdened by ''too many'' therapies. Given that patients of lower SES are less likely to mention ''stress reduction'' as one of their rehabilitation targets , they might particularly be less receptive to psychological treatment (Boesen et al 2007) and-despite experiencing higher psychosocial stress and having fewer resources at their disposal to handle stress (Skodova et al 2008)-less likely to perceive their situation as needing to be addressed during cardiovascular rehabilitation (Anderson et al 2006).…”

Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals

“…In addition to the core model that included sex, race/ethnicity, and the FRS for women and men, sensitivity analysis that included individual socioeconomic and lifestyle-related risk factors was also performed to demonstrate the robustness of depression and history of attempted suicide as predictors. 24,25 Covariates to be included in sensitivity analysis were chosen on the basis of theoretical plausibility, prior empirical findings, or demonstrated associations with depression or attempted suicide and mortality in this sample; they included income, education, body mass index, alcohol intake, sedentary lifestyle, and cocaine use.…”

Educational inequalities in ischaemic heart disease mortality in 44,000 Norwegian women and men: The influence of psychosocial and behavioural factors. The HUNT Study

“…social isolation, coping, and job stress) were used to measure psychosocial stress and only women younger than 66 years old were included in the study. The causal interrelationship between psychosocial and behavioural factors in the explanation of social inequalities in IHD mortality is complex [29] and was not the scope of this article.…”