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Psychosocial factors and prognosis in established coronary artery disease. The need for research on interventions.

The report by Frasure-Smith et al 1 in the current issue ofThe Journal, showing a fivefold higher mortality rate among depressed myocardial infarction survivors, should signal, we believe, a turning point in how we think about the role of psychosocial factors in the prognosis of coronary heart disease (CHD). The new findings indicate that rather than conducting additional studies to document yet again the adverse effects of psychosocial factors on prognosis, it is now time to develop and evaluate interventions aimed at ameliorating the harmful effects of these risk factors. A considerable body of evidence already clearly documents a strong adverse impact of social isolation on prognosis in CHD patients, independently of the severity of the underlying cardiac disease. 2-4 Several other studies, most using retrospective designs and self-report measures of depression, have also found increased cardiac event rates in CHD patients who are depressed. In their current report