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Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study

^a Department of Psychiatry and Behavioural Science, University of Auckland School of Medicine, Private Bag 92019, Auckland, New Zealand, ^b Unit of Psychology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE1 9RT, ^c Department of Medicine, University of Auckland School of Medicine

Correspondence to: Dr Petrie.

Abstract

Objective: To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction.
Design: Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later.
Setting: Two large teaching hospitals in Auckland, New Zealand.
Subjects: 143 consecutive patients aged under 65 with their first myocardial infarction.
Main outcome measures: Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction.
Results: Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t=2.08, P=0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t=-2.52, P=0.01) and have less grave consequences for the patient (t=-2.87, P=0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months.
Conclusions: Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.

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