UC San Diego

A plethora of research supports the association between socioeconomic status (SES) and physical and psychological health. More recently, the relationship between perceived or subjective social status (SSS) and health has been examined, consistently suggesting that SSS has predictive value above and beyond the influence of traditional objective SES indicators. The current study examined associations between objective SES and SSS and indicators of psychological well-being and recovery following acute coronary syndrome (ACS) - myocardial infarction or unstable angina. Participants were 90 patients recruited from UCSD Healthcare hospitals who met established criteria for ACS as confirmed by physician diagnosis. Questionnaire packets were administered at baseline (during hospitalization) and at 1-, 3-, and 6-months following the initial assessment. The MacArthur Scale of Subjective Social Status was used to assess participants' perceived status relative to others in their communities, and in the U.S. at large. SES was assessed by household income and educational attainment. Indicators of psychological adjustment to illness included scores on measures of depression (BDI-II) and anxiety (BAI), and indicators of recovery following the acute event included measures of self-reported health (SF-12) and disease- specific quality of life (SAQ). Multi-level modeling analyses showed that after controlling for demographic and health covariates, higher income was associated with less depression and anxiety, better self-reported mental and physical health/quality of life, and better cardiovascular health outcomes overall across the 6-month follow-up period. There were few significant findings for SSS, and only two remained significant once SES indicators were controlled. Limitations of the present study should be considered in the interpretation of its findings, and additional research, optimally with a larger sample and less attrition, would be helpful for ascertaining whether the results are generalizable to men and women, ethnically diverse populations, and patients experiencing diverse CHD stages. Despite these limitations, the current study contributes to knowledge about SES, SSS, and psychological factors that not only increase the risk of adverse outcomes, but may also influence an individual's ability to lead a fulfilling and functional life following ACS