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Marital Stress Causing Real Heartache

marital stress
The doctor is holding and showing a red heart. | Image by REDPIXEL.PL, Shutterstock

New research is shedding light on the role of marital stress during recovery following a heart attack. According to the study, individuals with “severe stress levels” experienced lower physical and even poorer mental health than those without.

Co-author Cenjing Zhu, a Ph.D. candidate in the department of chronic disease epidemiology at the Yale School of Public Health in New Haven, Connecticut, said in a press release from the Dallas-based American Heart Association (AHA), “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.”

The AHA says roughly 605,000 new and 200,000 recurrent heart attacks occur annually in the United States. Heart disease broadly kills one American every 34 seconds and is the leading cause of death in the country.

Previous studies have reported that social and psychological stress can worsen recovery from heart disease. Until now, however, studies have not focused on the role that stress from a relationship can play in the recovery process following a heart attack, specifically among younger adults.

The researchers studied 1,593 adults aged 18-55 across 103 hospitals in 30 states, all of whom had been admitted for heart attacks. Each participant was either married or in a “committed partnership” at the time of the cardiac arrest. Two-thirds of the participant’s study were women.

Subjects reported their stress levels via a questionnaire one month after the cardiac event. Depending on the answers, patient marital stress levels were considered “absent/mild,” “moderate,” or “severe.”

One year after the questionnaire, the authors studied individuals with “severe stress.” According to the researchers, on a 12-item scale, severely stressed patients scored 1.6 points lower in physical health and 2.6 points lower in mental health.

The study concluded that patients with severe stress scored “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.”

The authors also found a strong link between chest pains and marital stress. Patients with severe stress reported 67% higher instances of chest pain than those with mild or moderate stress. Hospital readmission rates were also found to be 50% higher among the severely stressed subjects.

Even when the researchers controlled for variables like age or sex, poor health outcomes surfaced. Women in the study, however, did report higher levels of severe marital stress. Nearly 4 out of 10 women were deemed to have severe marital stress compared to 3 out of 10 men.

According to Nieca Goldberg, a volunteer M.D. with the American Heart Association, “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.”

Controlling for employment, education, income, and health insurance status did reveal a reduced correlation, but “the link remained statistically significant.” The AHA also notes some other issues that may have affected the results. “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 U.S. hospitals, so the results may not apply to people who live in other countries; and because participants were only followed for up to one year after their heart attack, the results may not reflect long-term impact,” cautions the press release from the AHA.

Given what we now know, Zhu recommends that doctors “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.”

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