Coronary heart disease from a psychosocial perspective: socioeconomic and ethnic inequalities among Slovak patients

(2008) Zuzana Skodova

Promotor: Prof. Dr. S.A. Reijneveld

Copromotor: Assoc. Prof. Dr. JP van Dijk, Dr. L.J. Middel, Assoc. Prof. Dr. M. Studencan, Dr. I. Nagyova


Dissertation Skodova This thesis deals with socioeconomic and ethnic inequalities in psychological factors and in health-related quality of life among patients with coronary heart disease, as well as with psychosocial predictors of positive and negative changes in quality of life among patients with coronary heart disease (CHD). With regard to the psychological factors, the present study is focusing on the following most commonly researched characteristics: psychological well-being, vital exhaustion, Type D personality and hostility. Psychological well-being is characterized by the occurrence and severity of the depression and anxiety symptoms, which are strongly associated with the coronary heart disease. Vital exhaustion, a state characterized by lack of energy, increased irritability and feelings of demoralisation, is also known as one of the risk factors for coronary heart disease, and has been shown to be a substantial predictor of myocardial infarction. Type D personality defines individuals who experience increased negative emotions and who do not express these emotions in social interactions, and is associated with higher numbers of re-infarction and higher mortality rates among coronary patients. Hostility is comprising of cynicism, aggressive responding and hostile attitude toward the social environment, and has been demonstrated as a risk factor contributing to CHD as well. In the fi eld of CHD research, much attention has been paid in recent years to socioeconomic inequalities of those suffering from coronary heart disease. The role of socioeconomic disadvantage in CHD incidence, morbidity and mortality has been studied quite often, showing the importance of socioeconomic status (SES) in both the etiology and the prognosis of this disease. With regard to the quality of life and the psychological characteristics among patients, less attention has been paid to the possible associations with socioeconomic status. The incidence of the factors infl uencing coronary heart disease among minority ethnic groups is also becoming a point of the interest. In this regard, the effects of specific ethnic factors (e.g. cultural background, lifestyle differences) and an often low socioeconomic status play a signifi cant role. Within the framework of this thesis, SES is representing by the income level and educational grade as the most commonly used indicators of socioeconomic status.