The role of social support in health status and depressive symptoms after acute myocardial infarction: evidence for a stronger relationship among women

Abstract

Background: Prior studies have associated low social support (SS) with increased rehospitalization and mortality after acute myocardial infarction. However, relatively little is known about whether similar patterns exist for other outcomes, such as health status and depressive symptoms, and whether these patterns vary by sex.

Methods and results: Using data from 2411 English- or Spanish-speaking patients with acute myocardial infarction enrolled in a 19-center prospective study, we examined the association of SS (low, moderate, high) with health status (angina, disease-specific quality of life, general physical and mental functioning) and depressive symptoms over the first year of recovery. Overall and sex-stratified associations were evaluated using mixed-effects Poisson and linear regression, adjusting for site, baseline health status, baseline depressive symptoms, and demographic and clinical factors. Patients with the lowest SS (relative to those with the highest) had increased risk of angina (relative risk, 1.27; 95% confidence interval [CI], 1.10, 1.48); lower disease-specific quality of life (mean difference [beta]=-3.33; 95% CI, -5.25, -1.41), lower mental functioning (beta=-1.72; 95% CI, -2.65, -0.79), and more depressive symptoms (beta=0.94; 95% CI, 0.51, 1.38). A nonsignificant trend toward lower physical functioning (beta=-0.87; 95% CI, -1.95, 0.20) was observed. In sex-stratified analyses, the relationship between SS and outcomes was stronger for women than for men, with a significant SS-by-sex interaction for disease-specific quality of life, physical functioning, and depressive symptoms (all P<0.02).

Conclusions: Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.

Figure 1

Risk-Adjusted Models of SS and Outcomes SAQ, Seattle Angina Questionnaire; AF, Angina Frequency; QoL, Quality of Life; SF, Short Form; PCS, Physical Component Summary; MCS, Mental Component Summary; PHQ, Patient Health Questionnaire; RR, relative risk; CI, confidence interval; SS, social support. *Accounts for site and repeated outcome measures over time. Risk-adjusted for baseline health status, baseline depressive symptoms, age, sex, race, marital status, education, primary insurance, smoking status, prior coronary artery disease, hypertension, hypercholesterolemia, prior stroke/transient ischemic attack, congestive heart failure, chronic renal failure, chronic lung disease, left ventricular systolic dysfunction, final myocardial infarction diagnosis, coronary angiography during index hospitalization, and number of quality of care indicators eligible for during index hospitalization and percent of those received. †Adjusted for all of the above, except baseline health status. ‡p<0.02 for social support-by-sex interaction.