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EFFECTS OF PSYCHOLOGICAL AND SOCIAL FACTORS ON ORGANIC DISEASE: A Critical Assessment of Research on Coronary Heart Disease*
Key Words health psychology, cardiovascular disease, stress, depression, hostility
* Abstract An extensive research literature in the behavioral sciences and medicine suggests that psychological and social factors may play a direct role in organic coronary artery disease (CAD) pathology. However, many in the medical and scientific community regard this evidence with skepticism. This chapter critically examines research on the impact of psychological and psychosocial factors on the development and outcome of coronary heart disease, with particular emphasis on studies employing verifiable outcomes of CAD morbidity or mortality. Five key variables identified as possible psychosocial risk factors for CAD are addressed: acute and chronic stress, hostility, depression, social support, and socioeconomic status. Evidence regarding the efficacy of psychosocial interventions is also presented. It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing. However, continued progress in this area requires multidisciplinary research integrating expertise in cardiology and the behavioral sciences, and more effective efforts to communicate research findings to a biomedical audience.
INTRODUCTION
"... The evidence for mental state as a cause and cure of today's scourges is not much better than it was for the afflictions of earlier centuries .... In short, the literature contains few scientifically sound studies of the relation, if there is one, between mental state and disease ... it is time to acknowledge that our belief in disease as a direct reflection of mental state is largely folklore"' (Angell 1985).
These statements from an editorial in the prestigious New England Journal of Medicine continue to reflect the skeptical view of some in the medical community regarding the possible effects of stress, emotions, and personality traits on both chronic diseases (e.g., coronary heart disease, cancers, AIDS) and acute disorders (e.g., upper respiratory infections). There is an extensive accumulated behavioral science literature in health psychology and related fields that suggests the opposite conclusions, at least in terms of the influence of psychological factors on disease processes (Baum & Posluszny 1999, Cohen & Herber 1996, Kiecolt-Glaser et al. 2002, Krantz et al. 1985, Schneiderman et al. 2001). Therefore, this editorial assault aroused considerable...