Evidence based cardiology: Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies

BMJ 1999;318:1460-1467 ( 29 May )

Clinical review

Evidence based cardiology

Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies

Harry Hemingway, senior lecturer in epidemiology, Michael Marmot, professor of epidemiology and public health.

International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT

Correspondence to: Dr H Hemingway, Department of Research and Development, Kensington and Chelsea and Westminster Health Authority, London W2 6LX h.hemingway@public-health.ucl.ac.uk

The first 150 words of the full text of this article appear below.

Do psychosocial factors cause coronary heart disease or affect survival among patients with coronary heart disease? Here weuse an explicit methodological quality filter to review systematicallythe prospective cohort studies testing specific psychosocial hypotheses.This review of the epidemiological literature identifies the psychosocialfactors that have been most rigorously tested. Only four psychosocialfactors met the quality filter: type A/hostility, depression andanxiety, work characteristics, and social supports. The importanceof other study designs $---$ for example, ecological¹ or nested case-control^2-4studies $---$ is acknowledged. The review should be seen as complementaryto existing reviews^5-8 on single psychosocial factors and asa challenge to investigators in the field to ensure that the systematicreview is made unbiased, kept up to date, and used to guide futurehypothesis testing.

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What is a psychosocial factor?

A psychosocial factor may be defined as a measurement that potentially relates psychological phenomena to the social environmentand to pathophysiological changes. The . . . [Full text of this article]

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