Psychological and social factors in coronary heart disease.

More than six decades of empirical research have shown that psychosocial risk factors like low socio-economic status, lack of social support, stress at work and family life, depression, anxiety, and hostility contribute both to the risk of developing coronary heart disease (CHD) and the worsening of clinical course and prognosis in patients with CHD. These factors may act as barriers to treatment adherence and efforts to improve life-style in patients and populations. In addition, distinct psychobiological mechanisms have been identified, which are directly involved into the pathogenesis of CHD. In clinical practice, psychosocial risk factors should be assessed by clinical interview or standardized questionnaires, and relevance with respect to quality of life and medical outcome should be discussed with the patient. In case of elevated risk, multimodal, behavioural intervention, integrating counselling for psychosocial risk factors and coping with illness, should be prescribed. In case of clinically significant symptoms of depression and anxiety, patients should be referred for psychotherapy, and/or medication according to established standards (especially selective serotonin reuptake inhibitors (SSRIs)) should be prescribed. Psychotherapy and SSRIs appear to be safe and effective with respect to emotional disturbances; however, a definite beneficial effect on cardiac end-points has not been documented.