Spouse distress can hamper heart patient’s recovery

The spouses of heart attack sufferers may be more likely than patients themselves to suffer depression or anxiety in the aftermath - a fact that could stymie some patients’ recovery, research suggests.

The study, which included 417 patients who had recently had a heart attack or undergone surgery on diseased heart arteries, found that spouses generally had higher levels of depression and anxiety than the patients did. And when a spouse’s emotional distress was greater than the patient’s, it seemed to hinder the patient’s psychological and social recovery.

“This points to the importance of family members,” study co-author Debra K. Moser told AMN Health. “If they’re not in good shape, patients will do less well.”

Depression

Depression is the most common psychological problem in the US. Minor Depression can be attributed to normal depressed feelings that arise because of a specific life situation, a side effect of medication, hormonal changes or physical illness, and does not usually require treatment. Major Depression (depressive illness) is a serious condition that result in extreme fatigue, sleep problems and eventually an inability to function. The exact cause is unknown, but it is thought to be a malfunction of brain neurotransmitters, which are chemicals that modulate moods. Major Depression is usually treated with a combination of psychotherapy and antidepressants which moderate or correct chemical imbalances in the brain. The group of antidepressants most frequently prescribed is the selective serotonin reuptake inhibitors (SSRIs) which regulate the neurotransmitter serotonin.

Examples:
Amitriptyline HCL
WELLBUTRIN
Wellbutrin SR
Fluoxetine
Celexa
Lexapro
Paxil
Prozac
Remeron
Zoloft
Effexor XR

This is something health professionals have long felt to be true, according to Moser, a professor in the College of Nursing at the University of Kentucky in Lexington. The new findings give more insight into how a spouse’s emotional reaction affects a heart patient’s recovery.

Moser and colleague Kathleen Dracup looked specifically at patients’ “psychosocial” recovery, which considers things like anxiety and depression symptoms, feelings about the medical care received, relationships with family and friends, and the return to work.

Using standard surveys on emotional responses and adjustment to illness, the researchers found that 56 percent of spouses had higher than normal levels of anxiety, compared with half of patients. When it came to depression, 67 percent of spouses and 57 percent of patients were above the norm.

Moreover, when a patient’s spouse was more emotionally distressed than he or she was, the patient had a harder time adjusting to the illness. In contrast, patients showed the best psychosocial recovery when their spouses were less depressed and anxious than they were.

The stress of becoming a caregiver likely helps explain spouses’ generally higher levels of emotional distress, according to Moser. Add to that, she said, the fact that while patients may get support to reduce their anxiety and depression, spouses may receive no help to deal with their feelings.

Moser said a fairly simple way to begin to address the problem is by including spouses in their discussions with patients. Being part of this process may make the spouse feel more in control, and possibly lessen the emotional burden.

Past research has shown that heart patients’ own depression and anxiety may worsen their physical health, raising their risk of a repeat heart attack or dying in the months to years ahead. Moser said she will next look at how physical recovery may be affected by a spouse’s emotional state.

SOURCE: Psychosomatic Medicine, July/August 2004.

Provided by ArmMed Media
Revision date: June 21, 2011
Last revised: by Andrew G. Epstein, M.D.