title: Examining the Matthew effect on the motivation and ability to stay at work after heart disease.
abstract: OBJECTIVE
  Cardiac rehabilitation should safeguard that socioeconomic factors or other differences that affect people's cardiovascular health are not further aggravated after healthcare treatment. The study examines whether socioeconomic status, emotional problems, or the severity of disease affect people's ability to continue to work after heart disease. We also examined if these effects can be explained by differences in motivational factors.
  
  
  METHODS
  217 patients (41 women) from the Krokeide Rehabilitation Centre in Bergen participated. Multiple linear regression analysis was used to examine motivational differences, and logistic regression analysis was used to examine whether socioeconomic factors or other differences affected people's ability to continue to work after heart disease.
  
  
  RESULTS
  Self-efficacy for future work strongly impacted the likelihood of being incapacitated for work during the 2-year follow-up. The household's total income and emotional problems were statistically significant related to patients dropping out from work in the course of the observation. The association between emotional problems and future work was mediated by motivational problems. The relation between income and future incapacity for work could not be explained by motivational factors.
  
  
  CONCLUSIONS
  The study shows a clear Matthew effect on people's ability to continue to work after heart disease as low-income groups and people with emotional problems are more at risk of dropping out of work. This Matthew effect was, however, only explained by the motivational difficulties for the association between emotional distress and dropping out of work and not for the impact of household income on the likelihood of leaving work.
authors.affiliation: Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, NO-5018 Bergen, Norway. eivind.meland@isf.uib.no
authors.forename: Eivind
authors.initials: E
authors.lastname: Meland
authors.forename: Siri
authors.initials: S
authors.lastname: Grønhaug
authors.forename: Kristin
authors.initials: K
authors.lastname: Oystese
authors.forename: Thomas
authors.initials: T
authors.lastname: Mildestvedt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000523:psychology / Q000534:rehabilitation; D012050:Rehabilitation, Vocational; D012307:Risk Factors; D020377:Self Efficacy; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires