A study led by researchers at the Yale School of Public Health looked at how stress in marriage or a relationship affects the ability of young adults to recover from heart attacks.
The study found that marital stress was associated with worse recovery after a heart attack in people 18-55 who are married or in a relationship and that the stress may make it more difficult for younger adults to regain their physical and mental health after a heart attack.
Identifying marital and relationship stress in young adult patients who have had a heart attack might improve their health outcomes within the first year of recovery.
"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," Cenjing Zhu, the study's lead author and a recent doctoral graduate from chronic disease epidemiology at the Yale School of Public Health. Judith Lichtman, PhD ’96, MPH ’88, Susan Dwight Bliss Professor of Epidemiology (Chronic Diseases), is the senior author.
The study, which was funded by a grant from the National Heart, Lung, and Blood Institute (NHLBI), was published Aug. 17 in the Journal of the American Heart Association
Although there has been an overall reduction in cardiovascular disease prevalence and heart attack deaths in the U.S., the heart attack rates in people 55 and younger, especially women, has increased over the past four decades. Prior studies suggest that psychosocial factors may play an important role in heart attack incidence and post-heart attack hospital readmission, yet the impact of specific stressors on patient-reported outcomes remains poorly understood, especially among younger adults, according to the study.
Participants for the study were drawn from the NHLBI-funded VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. The 1,593 adults were treated for heart attacks from 2008-2012 and were either married or in a committed relationship with a partner when they had their heart attack. After self-reporting their levels of marital stress one month following their heart attack, the participants were classified as having stress that was absent/mild, moderate, or severe. Of the study participants, 36.2% reported severe marital stress, which was more common in female than male participants.
According to the study's authors, a marriage or committed relationship involves a close, ongoing relationship with someone who may be a significant source of support as well as stress. Unlike other stressors that are often time limited or situational, marital stress can be chronic and ongoing, they said. Although the sources and intensity of marital stress vary by life course stage, prior literature found that marital stress is highest among couples in their mid‐40s. Additionally, stress experienced in a marriage or committed relationship has been reported to influence post‐heart attack health outcomes, the authors said.
The authors also reported that young women are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress and develop mental stress‐induced myocardial infarction four times more often than similar‐aged men.Prior research from the VIRGO study also found that young women with acute myocardial infarction (AMI) experienced more depression and overall stress,which was associated with worse outcomes throughout their first year of recovery. However, the authors added, less is known about whether there are sex differences in the associations between marital stress and health outcomes in this younger population with AMI.
The authors concluded that the association between marital stress and worse one‐year health outcomes was statistically significant in young patients with AMI, suggesting a need for routine screening and the creation of interventions to support patients with stress recovering from a heart attack.
Among the study’s findings:
- In a cohort of young survivors of heart attack in the United States, over one-third reported severe marital stress (39.4% of women, 30.4% of men), which was significantly associated with worse health outcomes over the year after their discharge from the hospital.
- The association between severe marital stress and worse long-term health outcomes was statistically significant after adjusting for baseline health status, demographics, and socioeconomic status.
- No statistically significant differences between sexes were found in the associations between marital stress and health outcomes.
Content from an American Heart Association news release was used in this article.