Marital stress linked to worse recovery after heart attack
Research Highlights:
- Marital stress among younger adults (ages 18-55 years) was linked to worse recovery after a heart attack, compared to couples with less stress.
- Couples with severe marital stress had worse physical and mental health than those with mild or no marital stress one year after a heart attack.
- The link between marital stress and poor heart attack recovery was reduced yet remained significant after considering patient demographics (sex, age, race) and socioeconomic factors, such as education, employment, income and health insurance status.
- Women were more likely than men to report severe marital stress.
(NewMediaWire) -
"Health care professionals need to be aware of personal factors that may contribute to cardiac recovery and focus on guiding patients to resources that help manage and reduce their stress levels," said the study's lead author Cenjing Zhu,
According to the
Previous studies have found that psychological and social stress can lead to worse recovery from heart disease. While being married or partnered has been linked with better health and heart disease prognosis, what was unclear is if and how stress experienced in a marriage or romantic relationship (marital stress) may affect recovery after a heart attack, specifically among younger adults.
Zhu and colleagues compared recovery one year after a heart attack with self-reported marital stress. Study participants included 1,593 adults treated for a heart attack at 103 U.S. hospitals (located in 30 states across the country), who enrolled in another study called VIRGO, between 2008-2012. All participants were either married or in a committed partnership at the time of their heart attack. Participants were average age of 47 years 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, at one month after a heart attack, participants completed a 17-item questionnaire called the Stockholm Marital Stress Scale (a scale previously developed and tested in elderly female cardiac patients in
Participants were then followed for up to one year. Zhu and colleagues used a point scale to assess how participant's physical health may have limited his/her daily living activities, bodily pain and perceived health rating. The mental health component assessed participant's mental well-being and social interaction. Both stress and physical/mental health score were self-reported by the study participants. Hospital data was used to assess participant study eligibility and readmission data.
The analysis of the survey results compared with the hospitalization records indicate:
- Participants reporting severe stress levels scored more than 1.6 points lower in physical health, and 2.6 points lower in mental health on a 12-item scale.
- Participants reporting severe stress levels reported almost 5 points lower in overall quality of life, and 8 points lower in quality of life when measured by a scale specifically designed for cardiac patients.
- Participants reporting severe marital stress were 67% more likely to report chest pains than people with mild or no marital stress. In addition, the likelihood of being readmitted to the hospital for any cause increased by almost 50% among those who reported severe marital stress.
- More women than men reported severe marital stress in their survey responses, with almost 4 out of 10 women reporting severe marital stress vs. 3 out of 10 men.
- All study findings persisted after accounting for sex, age and race or ethnicity; while the strength of association was reduced after socioeconomic factors, including education, income, employment and health insurance status were included in the analysis, the link remained statistically significant.
"Our findings support that stress experienced in one's everyday life, such as marital stress, may impact young adults' recovery after a heart attack. However, additional stressors beyond marital stress, such as financial strain or work stress, may also play a role in young adults' recovery, and the interaction between these factors require further research," Zhu said. "Future efforts should consider screening patients for everyday stress during follow-up appointments to help better identify people at high risk for low physical/mental recovery or additional hospitalization. A holistic care model built upon both clinical factors and psychosocial aspects may be helpful, especially for younger adults after a heart attack."
"This study highlights the importance of evaluating the mental health of cardiac patients and is consistent with previous studies that show a greater burden of marital stress on the health of women," said
Several limitations may have affected the study's results: the levels of marital stress and health outcomes were self-reported, therefore, self-perception may affect results, which may be inaccurate; it included patients in specific
Co-authors are
The current study was funded by
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Additional Resources:
- Multimedia is available on the right column of the release link https://newsroom.heart.org/news/marital-stress-linked-to-worse-recovery-after-heart-attack?preview=5423301cad99f323367025b105a17eb7
- Link to abstract; and AHA Scientific Sessions 2022 Online Program Planner
- AHA news release: Mental health is important to overall health, and heart disease prevention and treatment (
Jan. 2021 ) - AHA news release: Social isolation and loneliness linked to increased risk of CVD in post-menopausal women (
May 2021 ) - AHA news release: Spouses of ICU patients may be at increased risk for cardiac events or hospitalization (
Oct. 2020 ) - AHA news release: Psychological stress may increase risk for a serious cardiovascular event in women with heart disease (
Nov. 2019 ) - For more news at AHA Scientific Sessions 2021, follow us on Twitter @HeartNews #AHA22
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