A new study shows strains and tensions in young adult marriages are linked to worse heart attack recovery. Scientists have called for greater awareness of patients' mental health.
The issue was found to affect women in particular because they are more likely to report severe marital stress than men. Researchers have said the study could pave the way for heart disease to stop being considered a one-organ illness and start being understood holistically - in relation to patients' mental health and personal circumstances too.
They suggested looking at heart disease patients' every day stresses could improve treatment and care, including financial strain and work stresses as well as marital issues. Heart and circulatory diseases cause a quarter of all deaths in the UK, killing 160,000 and causing 100,000 hospital admissions for heart attacks each year, according to the British Heart Foundation.
Previously studies found psychological and social stress can lead to a worse recovery from heart disease, but until now the impact of romantic stresses was unknown. The study results refine the current understanding that being married or partnered is linked with a better health and heart disease prognosis.
After discovering stress has a negative impact on heart disease recovery the study's lead author, Dr Cenjing Zhu, from Yale School of Public Health in New Haven, Connecticut, said more resources were needed to reduce people's stress levels. She said: "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."
Dr Zhu compared recovery a year after a heart attack in those who reported marital stress in the 1,593-person study. Her team ranked everyone on their physical health, mental health and stress levels using a self-reported 12-point scale.
Those who reported severe marital stress levels were 67% more likely to report chest pains than people with mild or no marital stress. They were also 50% to be readmitted to hospital.
On the 12-point scale those suffering severe marital stress scored 1.6 points lower in physical health on average, 2.6 lower in mental health, and five points lower in overall quality of life. This connection was likely to be particularly significant, because of the overall participants four in 10 women reported severe marital stress versus three in 10 men.
Dr Zhu said: "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.
“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 hospitalisation. A holistic care model built upon both clinical factors and psychosocial aspects may be helpful, especially for younger adults after a heart attack."
All of the patients in the American Heart Association study had been treated for a heart attack, and they spanned 103 US hospitals across 30 states. Every member of the group was married or in a committed partnership when they suffered a heart attack.
They had an average age of 47 years and were made up of 1,199 (75.3%) white adults, 205 (12.9%) black adults, 109 (6.8%) Hispanic adults. Over two-thirds were women.
To assess the level of marital stress one month after their heart attack participants took a 17-item questionnaire that included the quality of the emotional and sexual relationship with their spouse or partner. As a result of their responses they were put into three groups: absent or mild marital stress, moderate marital stress or severe marital stress.
Dr Zhu and her team followed up participants for up to a year and used a scale to measure how a participants' physical health could limit their daily activities such as bodily pain or perceived health. Stress-levels and physical and mental health were self-reported too.
Professor Nieca Goldberg, American Heart Association expert volunteer, said: "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. A comprehensive approach to the care of cardiac patients that includes physical and mental health may transform the care of cardiac patients from the care of one organ to a patient’s global health.
"The health care system should support the clinical assessment of both physical and mental health as that may lead to better outcomes and healthier lives for our patients." The research is due to to be presented at the American Heart Association’s Scientific Sessions later this week.
