Marital stress is linked to poorer recovery after a heart attack

According to a study presented at the American Heart Association’s 2022 Scientific Sessions, marital stress in young adults (ages 18 to 55) is associated with poorer recovery after a heart attack. This negative impact did not change significantly after controlling for demographic and socioeconomic factors, such as education, employment, income, and health insurance status.

“Healthcare professionals should be aware of the personal factors that can contribute to cardiac recovery and focus on guiding patients to resources that help them manage and reduce their stress levels,” explains the lead author of study, Cenjing Zhu, a doctoral student in the Department of Chronic Disease Epidemiology at Yale School of Public Health, USA.

Previous studies have shown that psychological and social stress can lead to poorer recovery from heart disease. Although being married or in a relationship was associated with a better prognosis for health and heart disease, what was unclear is if and how stress experienced in a marriage or relationship love (marital stress) can affect recovery from a heart attack, especially in young adults.

Zhu and her colleagues compared recovery one year after a heart attack with self-reported marital stress. Study participants were 1,593 adults being treated for a heart attack at 103 US hospitals (located in 30 US states), who had been enrolled in another study called VIRGO, between 2008 and 2012. All participants were married or in couple at the time of their heart attack. Participants had an average age of 47 and included 1,199 (75.3%) white adults, 205 (12.9%) black adults, 109 (6.8%) Hispanic adults, and more than two-thirds were women.

To measure marital stress, one month after the heart attack, participants completed a 17-item questionnaire called the Stockholm Marital Stress Scale (a scale previously developed and tested in elderly heart patients in Stockholm, Sweden, which assesses marital stressors, including the quality of the emotional and sexual relationship with the spouse or partner). The researchers categorized the participants based on their responses to the questionnaire into three groups: low/none marital stress, moderate marital stress, or severe marital stress.

Participants were then followed for a year. Zhu and colleagues used a point scale to assess how much participants’ physical health limited their activities of daily living, body pain, and perceived health rating. The mental health component assessed participants’ mental well-being and social interaction. Stress and physical/mental health scores were self-reported by study participants. Hospital data was used to assess study participant eligibility and readmission data.

Analysis of survey results compared with hospital records indicates that participants who reported high levels of stress scored more than 1.6 points lower in physical health and 2.6 points for mental health on a 12-point scale. In addition, people who reported high levels of stress reported nearly 5 points lower overall quality of life, and 8 points lower quality of life when measured by a specially designed scale. designed for heart patients.

Participants reporting severe marital stress were 67% more likely to report chest pain than those with mild or no marital stress, and the likelihood of hospital readmission for any cause increased nearly 50% among people who reported severe marital stress. In their survey responses, women are more likely than men to report severe marital stress: nearly 4 in 10 women reported severe marital stress, compared to 3 in 10 men.

All study results held after controlling for gender, age, and race/ethnicity; although the strength of the association was reduced after inclusion in the analysis of socioeconomic factors such as education, income, employment, and health insurance status, the association remained statistically significant.

“Our results confirm that stress experienced in daily life, such as marital stress, can affect young adults’ recovery from a heart attack. However, stressors other than marital stress, such as financial stress or job stress, may also influence recovery in young adults, and the interplay between these factors requires further research,” notes Zhu.

“Future efforts should consider screening patients for daily stress at follow-up appointments to better identify those at high risk for poor physical/mental recovery or re-hospitalization,” he suggests. A holistic model of care based on both clinical factors and psychosocial aspects may be helpful, especially for young adults after a heart attack. »

Nieca Goldberg, volunteer expert for the American Heart Association, associate professor of clinical medicine at New York University Grossman School of Medicine and medical director of Atria NY, notes that “this study underscores the importance of evaluating the mental health of heart patients and is consistent with previous studies showing that marital stress weighs more heavily on women’s health.

As he points out, “a holistic approach to cardiac patient care that includes physical and mental health can transform cardiac patient care from organ care to overall patient health. The healthcare system should support clinical assessment of physical and mental health, as this can lead to better outcomes and healthier lives for our patients.