deaths in men and 2721 deaths in women per million in 1992. It has been estimated
that CHD cost the UK National Health Service (NHS) about £390 million in 1985–86.
The highest death rates from CHD are found in men and women in the manual classes,
and men and women of Asian origin. In middle age, the death rate is up to five times
higher for men than for women; this evens out, however, in old age when CHD is the
leading cause of death for both men and women. Interestingly, women show poorer
recovery from MI than men in terms of both mood and activity limitations.Risk factors for CHD
Many risk factors for CHD have been identified. Some of these are regarded as (1)
non-modifiable, such as educational status, social mobility, social class, age, gender,
stress reactivity, family history and ethnicity; or (2) modifiable, such as smoking
behaviour, obesity, sedentary lifestyle, perceived work stress and personality. However,
whether some of the latter can be changed is debatable.The role of psychology in CHD
The role of psychology in CHD will now be examined in terms of (i) beliefs about CHD;
(ii) the psychological impact of MI; (iii) predicting and changing behavioural risk factors;
and (iv) patient rehabilitation.Beliefs about CHD
Chapter 3 described the kinds of beliefs people have about their illness and explored how
these beliefs may influence the development and progression of the disease. Some
research has specifically examined the beliefs people have about CHD with a particular
focus on beliefs about causes. For example, French et al. (2002) explored how members
of the general public understand MI and differentiated between beliefs about proximal
causes that directly cause MI and distal causes that are mediated by other causal factors.
The results showed that even though the respondents did not have CHD they still had
quite complex beliefs about its causes. In particular, type of work was seen as a distal
cause of MI which operated through stress and high blood pressure, stress was seen to
operate via raised blood pressure rather than behaviour and genes were seen to have a
direct effect on CHD which was not mediated by any behavioural or physiological
processes. Gudmundsdottir et al. (2001) also explored people’s beliefs about CHD but
examined the beliefs of people who had had an MI in the past year. Using a longitudinal
design they assessed the patients’ beliefs within 72 hours of admission into hospital and
interviewed the patients about the causes of their MI. They were then followed up three
times over the next year. In addition, the study used four different types of methods
to explore causal attributions. These were spontaneous attributions (i.e. responses to an
open question about the illness), elicited attributions (i.e. responses to an open question
about the cause of the MI), cued attributions (i.e. responses to a list of possible causes)
and most important attribution (i.e. selected cause from the given list). The results372 HEALTH PSYCHOLOGY