title: Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study.
abstract: OBJECTIVE
  To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI).
  
  
  METHODS
  A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism.
  
  
  RESULTS
  The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47-0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score.
  
  
  CONCLUSIONS
  Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI.
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
authors.forename: Netanela
authors.initials: N
authors.lastname: Weiss-Faratci
authors.affiliation: Kfar Saba Adult Clinic, Shalvata Mental Health Center, Hod Hasharon, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Lurie
authors.affiliation: Bob Shapell School of Social Work, Tel Aviv University, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Benyamini
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Gali
authors.initials: G
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: yarivg@post.tau.ac.il.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
mesh_terms: D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology*; D000067656:Optimism / Q000523:psychology*; D016016:Proportional Hazards Models; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data