In a recent study soon to be presented at the American Heart Association (AHA) Scientific Sessions 2022*, researchers examined the adverse effects of marital stress (MS) on recovery from acute myocardial infarction (AMI).

The AHA has stated that heart diseases such as AMI are the most common reason for death in the United States (US). Studies have reported that social and psychological stress can worsen heart disease recovery. In addition, studies have associated being in a partnership or marriage with improved health and prognosis of heart disease. However, it is unclear whether and in what ways MS might affect AMI recovery, especially among young adult individuals.

Study: Impact of Marital Stress on 12-month Health Outcomes Among Young Adults With Acute Myocardial Infarction. Image Credit: Ground Picture / Shutterstock

About the study

In the present study, researchers examined MS's effects on AMI recovery.

The team compared recovery a year after AMI among 1593 adult individuals with MS who reported being treated for AMI (at 103 hospitals in 30 US states) and who were recruited for the VIRGO (variation in recovery: role of gender on outcomes of young AMI patients) study, which was conducted from 2008 to 2012. The study participants ranged in age from 18 to 55 years and were either in a committed relationship or married when they experienced an AMI attack.

For the MS measurements, participants filled out the 17-component Stockholm scale MS questionnaire a month after their AMI, which assesses marriage-related stressors, including the quality of their sexual and emotional relationships. Based on the MS scores, participants were categorized into no/mild MS, moderate MS, and severe MS groups, and follow-up assessments were performed for 12 months.

A 12-item scale was used to assess the impact of physical health on the performance of daily activities, physical pain, and ratings of perceived health. The questionnaire's mental health category assessed participants' social interactions and psychological well-being. Mental/physical health scores and MS were documented by the participants themselves. In addition, data obtained from hospitals were analyzed to identify eligible participants and readmissions.

The main study outcomes were the status of mental/physical health, disease-specific/general QoL (quality of life), depression symptoms, angina, and any-cause hospital readmissions one year after AMI. Logistic and linear regression modeling types were used for the analysis with data adjusted for the status of health, demographical variables, and various socioeconomic factors (such as the level of education, income levels, health insurance coverage, and employment status). 

Results

The average age of the participants was 47 years, and 75% (n=1199), 13% (n=205), and seven percent (n=109) were Whites, Blacks, and Hispanics, respectively, with most (>67%) of the study participants being female. Recovery after AMI was delayed for those with MS compared to those in less stressful marriages. Partners with severe MS had poorer mental and physical health 12 months after AMI than couples without/with mild MS.

Women (39%) showed a greater likelihood of reporting severe MS than men (30%). Similar results were observed after adjusting for age, race, sex, and socioeconomic factors with a smaller but statistically significant association. A comparison of the survey findings with the hospitalization data showed that the study participants with self-reported severe MS scores had a physical and mental health score >two points and >three points worse, respectively.  

Severe MS was also associated with 5.0 and 8.0-points lower general and heart-specific QoL scores, respectively, and higher depression and angina scores 12 months after AMI. In addition, the odds of being readmitted to the hospital and complaining of chest pain were 50% and 67% higher in those with severe MS, respectively, than in those without and with mild MS.

Conclusions

Overall, the preliminary research findings to be presented at AHA's Scientific Sessions 2022 showed that MS negatively affects AMI recovery among young adults; however, in addition, other stressors, such as work-related stress or economic burden, may affect AMI recovery. The study's results highlight the need for a mental health assessment for cardiovascular patients.

Future studies need to be conducted on an international scale with objective data and long-term assessments of the associations between all stressors and AMI recovery. Healthcare professionals need to assess stress levels in hospitalized and non-hospitalized individuals to evaluate the need for re-hospitalization and the prognosis of individuals with heart disease. Integrating psychosocial components into the care of cardiac patients would improve the overall standard of care.

C. Zhu, M.Phil., and a Ph.D. candidate in the Yale School of Public Health's chronic disease epidemiology department in Connecticut, said, "Healthcare 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."

*Important notice

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.  

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.