Behavioral Factors, Life Changes, and the Development of Vital Exhaustion and Depression in Myocardial Infarction Patients

Abstract

Epidemiological studies on psychosocial precursors of myocardial infarction (MI) in middle-aged subjects suggest that in the year prior to MI, psychological phenomena of 'vital exhaustion and depression' may be an equally important diagnostic measure as manifestations of chest pain, and other cardiac symptoms. A self-administered psychological survey the 'Maastricht Questionnaire' (MQ) was constructed in order to measure the prodromal phenomena of 'vital exhaustion and depression'. In this paper, several retrospective and longitudinal studies on MI patients and controls are commented on in which the MQ was employed. Since these studies as such cannot explain why an association exists, a retrospective investigation in a sample of 136 healthy middle-aged men was undertaken. In this study, the interrelationships between the Type A coronary-prone behavior pattern, exposure to stressful life changes over a two year period, and the association with the MQ were explored. Coronary-prone behavior was assessed through the Jenkins Activity Survey (JAS), exposure to stressful life changes through our Middle Adulthood Life Changes Questionnaire (MALC), which is described in full. It is demonstrated that manifestations of 'vital exhaustion and depression' are associated in particular with life changes in the Home & Social domain on the MALC, and with Type A coronary-prone behavior. The latter is associated also in particular with life changes connoting work involvement and conflict proneness in the Work & Career domain on the MALC. The extended MALC, now covering the whole human life span, and the MQ are current employed in a case-control study on MI patients, neighborhood and hospital controls in order to explore further the ontogenetic factors that may be conducive to the development of 'vital exhaustion and depression', and subsequent MI. Methodological considerations for extending the MALC are discussed, together with an illustrative case history on a MI patient from this study.