Psychosocial factors in the Northern Sweden MONICA project

During the last 10 to 15 years there has been a very rapid reduction of cardiovascular deaths, in the north of Sweden as well as in the rest of the country (1). But traditional risk indicators such as hypertension, smoking, high cholesterol levels, and obesity can still only explain about half of the variance in cardiovascular morbidity. This lack of explaining power by the traditional risk indicators has stimulated search for new risk indicators, mainly of a psychosocial character. There are a number of studies trying to shed light on the connection between psychosocial factors and cardiovascular morbidity (2). It has long been known that work and a long education seem to stimulate the absence of cardiovascular morbidity, while poor economy and unemployment seem to increase these problems (3). A vast literature has documented the close connection between socioeconomic status and risk for cardiovascular diseases (3). Marital status has in a number of studies been predictive for cardiovascular events (2). Living in rural areas has also shown to be of importance – whether it depends on selection or exposure rural living seems to be connected to a higher risk for cardiovascular diseases (4). The question of social support and social network has also been studied in detail. In Sweden both Hansson and Ostergren have presented support for the theory that weak social support and lack of social network increases the vulnerability for cardiovascular morbidity (5, 6). One very simple indicator of social support and network is the marital status of a person but there are also more sophisticated measures that try to pinpoint both quantity and quality of social relations. In this study social support was measured by the ISSI questionnaire (7). Two sub-scales were used: availability of social interaction (giving a more quantitative measure) and availability of attachment (trying to grasp more qualitative aspects of the support). The focus of this paper is to describe the change of the psychosocial risk indicators over time.