Having few friends, family and a general lack of social support is associated with poor health and quality of life and depression in young men and women a year after having a heart attack, according to new research in the Journal of the American Heart Association.
Social support is the perception of having friends or family who serve as confidants and companions, offer advice and information, show emotional concern, or provide financial or material support, said Emily Bucholz, lead researcher and a student in the School of Medicine and the Department of Chronic Disease Epidemiology in the Yale School of Public Health in New Haven, Connecticut.
The findings linking the relationship between social support and health outcomes in heart attack patients are consistent with previous studies centered on older people, mostly men. But this study adds the new dimension of younger patients and women, and presents the opportunity to consider changes in guiding patients after heart attacks.
"Studies like this are opening up a wide list of different types of risk factors than the ones we conventionally think about," said Harlan Krumholz, M.D., S.M., the study's senior author and director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, and a professor in Yale's schools of medicine and public health.
"We shouldn't just be concerning ourselves with pills and procedures," Krumholz said. "We have to pay attention to things like love and friendship and the context of people's lives. It may be that these efforts to help people connect better with others, particularly after an illness, may have very powerful effects on their recovery and the quality of their lives afterwards."
Researchers evaluated self-reported social support from 3,432 heart attack patients (ages 18-55) and surveyed them at one and 12 months. The patients were from the VIRGO study (Recovery in Variation: Role of Gender on Outcomes of Young AMI Patients), a research project observing younger patients after heart attack, particularly women, from the United States and Spain.
Patients were categorized as having low, moderate or high social support focused on health status, physical and mental functioning, depressive symptoms and disease-related quality of life. Twenty-one percent were classified as having low social support. Men and women had comparable social support levels.
At initial examination, patients with low social support were more likely to:
- be single
- live alone
- abuse alcohol and
- have cardiovascular risk factors, including high blood pressure, diabetes and depression.
One month and 12 months following a heart attack, on average, patients with low social support had:
- lower mental functioning
- lower quality of life and
- more depressive symptoms.
Surprisingly researchers did not observe gender differences even though clear gender differences had been reported in previous social support studies involving older patients.
Currently, social support factors are not included in risk models used to evaluate patients after heart attack, but they are strong predictors of health outcomes.
"This study adds to current literature by showing that there may be some utility in being able to identify patient support networks when patients are first hospitalized for heart attack," Bucholz said.
"Research such as this is one of the reasons the American Heart Association/American Stroke Association has launched its Support Network for people living with heart disease and stroke, for parents of children with congenital heart defects and for family and caregivers," said Barry J. Jacobs, Psy.D., an AHA/ASA volunteer and Director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa. "The Network offers a place for people to find and share emotional support from others who are going through similar journeys. Sharing stories, experiences and practical advice can really make a positive impact in how we face these challenges."
Other co-authors of the study are Kelly Strait, M.S.; Rachel P. Dreyer, Ph.D.; Mary Geda, M.S.N., R.N.; Erica Spatz, M.D., M.H.S.; Hector Bueno M.D., Ph.D.; Judith Lichtman, Ph.D., M.P.H.; Gail D'Onofrio, M.D., M.S.; and John Spertus, M.D., M.P.H. Author disclosures are on the manuscript.
The National Heart, Lung, and Blood Institute partially funded the study. Other funding is on the manuscript.
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Journal of the American Heart Association