Heart Disease Occurs in a Biological, Psychological, and Social Matrix: Cardiac Risk Factors, Symptom Presentation, and
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ORIGINAL ARTICLE
Heart Disease Occurs in a Biological, Psychological, and Social Matrix: Cardiac Risk Factors, Symptom Presentation, and Recovery as Illustrative Examples Jerry Suls, Ph.D. & René Martin, Ph.D., R.N.
Published online: 25 November 2010 # The Society of Behavioral Medicine 2010
Abstract Despite the basic premise of behavioral medicine that understanding and treatment of physical well-being require a full appreciation of the confluence of micro-, molar-, and macro-variables, the field tends to focus on linear, causal relationships. In this paper, we argue that more attention be given to a dynamic matrix approach, which assumes that biological, psychological, and social elements are interconnected and continually influence each other (consistent with the biopsychosocial model). To illustrate, the authors draw from their independent and collaborative research programs on overlapping cardiac risk factors, symptom interpretation, and treatment delay for cardiac care and recovery from heart disease. “Cabling” across biological, psychological, and social variables is considered as a transformative strategy for medicine and the other health-related disciplines.
This study is based on a Master Lecture delivered by J. Suls at the 2010 Annual Meeting of the Society of Behavioral Medicine, Seattle, Washington. Research described here was supported by NIA AG024159 to JS, NIR 009292 to RM, and AHA 071001Z. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. J. Suls (*) Department of Psychology, E-11 SSH, Spence Laboratories, University of Iowa, Iowa, IA 52242, USA e-mail: [email protected] R. Martin Center for Research in the Implementation of Innovative Strategies in Practice, Veterans Affairs, Medical Center, Iowa, IA, USA R. Martin College of Nursing, University of Iowa, Iowa City, IA, USA
Keywords Cardiovascular behavioral medicine . Heart disease . Gender disparities . Affective dispositions . Biopsychosocial model . Treatment delay
Intoduction Cardiac disease poses a significant public health problem. In 2006, 26% of deaths in the USA resulted from heart disease [1]. Contrary to a common misimpression, coronary heart disease (CHD) is an “equal opportunity” killer, as the leading cause of death for both men and women; in fact, one half of the deaths due to heart disease were women [1]. Although improvements in emergency and medical care procedures have improved survival rates from heart attack, about 470,000 people who have already had one or more attacks will have another [2]. The National Center for Health Statistics [3] estimated that heart disease will cost the USA $316.4 billion from cost of health care services, medications, and lost productivity. Modern medicine is responsible for many advances in heart disease prevention and care. Although the medical community also acknowledges the important role of behavior in cardiac risk, diagnosis, and recovery, behavior receives much less recognition and support than
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