We investigated psychosocial and clinical factors related to work resumption, delay in returning to work and level of work activity after an acute myocardial infarction in Japanese male patients. A total of 111 married male patients experiencing a first acute myocardial infarction, aged less than 66 years and in full-time employment participated. Interviews and questionnaires were administered during hospitalization to assess potential predictors of work-related outcomes, with follow-up (81.6%) after an average of 8 months. We found that failure to return to work was predicated independently by older age (P=0.019), an introverted personality (P=0.011) and the presence of depressive symptoms during hospitalization (P=0.031). Delay in returning to work was predicted by greater concerns about health (P=0.011), low social support (P=0.021), and a failure to recognise a link between stress, coping style and illness (P=0.001). Resuming work at a lower activity level than before infarction was associated with older age (P=0.008), higher health concerns (P=0.012), and patients' predictions of their lower work activity (P=0.001). Clinical indices of infarction size and disease severity did not predict work-related outcomes. We conclude that psychosocial factors are associated with work resumption in Japanese men characterised by a job-centred lifestyle, with different factors being important for different work outcomes. The psychosocial factors found to be important are similar to those identified in Western societies.