Therecognitionthatpsychosocialriskfactorscontributetothepathogenesisofcardiovasculardiseasehasledtothedevelopmentofanewfieldofbehavioralcardiology.Theinitialimpetusforthisfieldwasstudiesperformedinthe1980sand1990sthatprovidedepidemiologicalevidenceandapathophysiologicalbasisforastronglinkbetweenanumberofpsychosocialriskfactorsandcardiovasculardisease,includingdepression,anxiety,hostility,jobstress,andpoorsocialsupport.Inrecentyears,additionalpsychosocialriskfactorshavebeenidentified,includingpessimism;otherformsofchronicstress,suchaschildhoodabuseandtrauma,andthepsychologicalstressthatmaybeassociatedwithchronicmedicalillness;lackoflifepurpose;andthesyndromeof“vitalexhaustion,”whichconsistsofatriadofexhaustion,demoralization,andirritability.Newresearchinthelastdecadehasalsoestablishedthatpositivepsychosocialfactors,suchasoptimism,positiveemotions,avibrantsociallife,andastrongsenseoflifepurpose,canhaveanimportanthealth-bufferingeffectthroughtheirfavorableinfluenceonhealthbehaviorsandpromotionofpositivephysiologicalfunctioning.Patientscanbescreenedforpsychosocialriskfactorsinclinicalpracticethrougheithertheuseofopen-endedquestions,whichcanbeintegratedintoaphysician’sstandardreviewofsystems,ortheuseofshortquestionnaires.Physicianscanassistinthetreatmentofpsychosocialriskfactorsinvariousways,suchasscreeningpatientsforpsychologicaldistressandmakingappropriatereferralswhenindicated,providingpatientswithpracticallifestylesuggestions,andemployingofficepersonneltoteachpatientsbehavioralorpsychosocialinterventionsthatcanpromoteasenseofwell-beingand/orreducestress.
