Background: Spouses of post myocardial infarction patients are affected by the cardiac event as an intimate individual within a family unit. Spouses are key individuals to influence patient health outcomes. Psychological distress of spouses may increase their risk of a cardiovascular disease. Few studies have addressed longitudinal changes in psychosocial status of spouses of post myocardial infarction patients. Purpose: This study examined changes in psychosocial factors (depression, coping, social support amount, and social support satisfaction) for spouses of post myocardial infarction patients over two years based on three realms from the biopsychosocial model. Parsimonious models were developed for predicting changes in each outcome for all spouses and psychologically distressed subgroups. Methods: This study was a secondary analysis of data from the Patients' and Families' Psychological Response to Home Automated External Defibrillator Trial (PRHAT) study. The PRHAT study was designed to compare the long-term effects of cardiopulmonary resuscitation (CPR) training and automated external defibrillator (AED) plus CPR training group on anxiety and depression in patient couples (N=442). Linear mixed models analyses (SPSS 17.0) were used to examine predictors of change over time. Results: Depression and social support satisfaction did not change, but coping and social support amount decreased over time. In the parsimonious models, depression increased over time for spouses who had: lower baseline depression; lower social support satisfaction; or patients with higher baseline depression. Coping rapidly decreased over time for spouses who had: higher baseline coping scores; or patients who experienced MI recently. Social support amount decreased or slowly increased over time for spouses who had higher social support amount at baseline among all spouses and distressed spouses. Social support satisfaction decreased over time for spouses who had higher baseline social support satisfaction among all spouses and anxious spouses. Social support satisfaction increased over time for depressed spouses in the CPR/AED group regardless of baseline social support satisfaction. Conclusion: Spouse baseline psychosocial variables influenced changes in spouse depression, coping, or social support over time. Spouse psychosocial status deteriorated over time. Psychosocial status of patients influences spouses' psychosocial status.