Social Support and Prognosis in Patients at Increased Psychosocial Risk Recovering From Myocardial Infarction

Duke University, Durham, North Carolina, United States
Health Psychology (Impact Factor: 3.59). 08/2007; 26(4):418-27. DOI: 10.1037/0278-6133.26.4.418
Source: PubMed


To compare the impact of network support and different types of perceived functional support on all-cause mortality or nonfatal reinfarction for patients with a recent acute myocardial infarction (AMI).
Participants were recruited from the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 2,481 AMI patients with depression or low social support were randomized to a cognitive-behavioral intervention or to a usual care control group. Data collection for certain measures of social support was limited: 2,466 participants completed the ENRICHD Social Support Inventory; 2,457 completed the Perceived Social Support Scale; 1,296 completed the Social Network Questionnaire; and 707 completed the Interpersonal Support and Evaluation List, Tangible Support subscale. Patients also completed the Beck Depression Inventory and were followed for up to 4.5 years.
Time to death or nonfatal reinfarction.
Over the follow-up period, 599 patients (24%) died or had a nonfatal AMI. Survival models controlling age, sex, race, socioeconomic status, smoking, antidepressant use, and a composite measure of increased risk revealed that higher levels of perceived social support were associated with improved outcome for patients without elevated depression but not for patients with high levels of depression. Neither perceived tangible support nor network support were associated with more frequent adverse events.
AMI patients should be assessed for multiple dimensions of perceived functional support and depression to identify those at increased psychosocial risk who may benefit from treatment.

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    • "According to Cohen and Wills (1985, p. 310), social support protects individuals from ''the potentially pathogenic influence of stressful events;'' alternatively, the negative impact of stress is augmented in individuals lacking support. Social support is the coping resource that has received the most attention in the CHD literature (Chung et al., 2013; Friedmann et al., 2014; Graven & Grant, 2013; Heo et al., 2014; Lett et al., 2005, 2007). Recent studies have examined the effects of social support on changes in depression in CHD inpatients and outpatients, yet none have assessed its stress-buffering role. "
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    ABSTRACT: Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.
    Full-text · Article · Dec 2015 · Journal of Behavioral Medicine
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    • "However, all analyzed studies have some limitations. The majority of them did not measure the quality of marital or social relationships, but assesses only the presence of marital status or social relationship (Lett et al., 2007; Empana et al., 2008; Chung et al., 2009); some of them present methodological limitations, such as the lack of adequate control groups (Lett et al., 2007), a high gender imbalance (Shen et al., 2004) and the use of a single-item scale (Thurston and Kubzansky, 2009). "
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    ABSTRACT: Background: Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease. However, little is known about the hypothetical relationship pattern between them. Purpose: The purposes of this narrative review are (1) to appraise the 2002–2012 empirical evidence about the multivariate relationship between depression, social support and health outcomes in patients with heart disease; (2) to evaluate the methodological quality of included studies. Method: PubMed and PsychINFO were searched for quantitative studies assessing the multiple effects of low social support and depression on prognosis outcomes in patients with heart disease. The following search terms were used: social relation*, cardiac disease, support quality, relationship, and relational support. Results: Five studies (three prospective cohort studies, one case-control study, and one randomization controlled trial) were selected and coded according to the types of support (social and marital). The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations. Conclusion: Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients.
    Full-text · Article · Jul 2013 · Frontiers in Psychology
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    • "A large body of research recognises the health benefits of social support, and has indicated that social isolation increases susceptibility to ill health from a number of causes (Berkman, 1995; Itkowitz, Kerns, & Otis, 2002; Pearlin, et al., 1981). In particular, social support has been associated with better outcomes in patients with cardiovascular illness (Lett, et al., 2007). However a degree of vagueness in the definition and measurement of social support has led to conflicting results, with some studies showing that dimensions of social support may in fact increase the risk of negative outcomes (Itkowitz, et al., 2002; Schieman & Meersman, 2004). "

    Full-text · Article · Jan 2011
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