Social support buffers the negative effects of stress in cardiac patients: a cross-sectional study with acute coronary syndrome patients
Cardiac patients who have social support generally have better prognosis than patients who lack social support. Several theoretical mechanisms have been proposed to explain this protective effect, including the capacity of social support to buffer the negative effects of stress. We tested this buffering effect in a study of patients hospitalized for acute coronary syndrome (ACS) in Spain. Several days after the cardiac event patients answered a questionnaire measuring stressful events during their lifetime, perceived social support around the time of the cardiac event, and depression symptoms in the past week. Results showed that stressful life events were related to depressive symptoms and worse renal function post-ACS only among patients with low perceived social support. Among patients who reported enough social support, lifetime stress was not related to depressive symptoms. No similar effects were observed on other prognostic indicators such as troponin levels or the number of obstructed arteries. These results suggest that social support can buffer the negative effects of stress on the mental and physical well-being of cardiac patients.
KeywordsSocial support Mental health Stress Depression Cardiovascular disease
This research is part of the self-funded project “PySCA: Study on the impact of psychological factors in acute coronary syndrome” (Principal Investigator: JARH). Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness. Financial support was partially provided by the Ministerio de Economía y Competitividad (Spain) (PSI2011-22954 and PSI2014-51842-R).
Compliance with ethical standards
Conflict of interest
Simona Wiesmaierova, Dafina Petrova, Antonio Arrebola Moreno, Andrés Catena, José Antonio Ramírez Hernández and Rocio Garcia-Retamero declare independence from the funding agencies and do not have conflicts of interest including financial interests, activities, relationships, and affiliations.
The Ethics Committee of the University Hospital Virgen de las Nieves in Granada, Spain, provided approval for the study.
Human and animal rights and Informed consent
All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio, 78, 490–498.Google Scholar
- Berkman, L. F., Blumenthal, J., Burg, M., Carney, R. M., Catellier, D., Cowan, M. J., et al. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The enhancing recovery in coronary heart disease patients (ENRICHD) randomized trial. JAMA, the Journal of the American Medical Association, 289, 3106–3116.CrossRefPubMedGoogle Scholar
- Blasco-Fontecilla, H., Delgado-Gomez, D., Legido-Gil, T., De Leon, J., Perez-Rodriguez, M. M., & Baca-Garcia, E. (2012). Can the Holmes–Rahe social readjustment rating scale (SRRS) be used as a suicide risk scale? An exploratory study. Archives of Suicide Research, 16, 13–28.CrossRefPubMedGoogle Scholar
- Cukor, D., Peterson, R. A., Cohen, S. D., & Kimmel, P. L. (2006). Depression in end-stage renal disease hemodialysis patients. Nature Reviews Nephrology, 2, 678–687.Google Scholar
- Fernandez, A., Garcia-Alonso, J., Royo-Pastor, C., Garrell-Corbera, I., Rengel-Chica, J., Agudo-Ugena, J., et al. (2015). Effects of the economic crisis and social support on health-related quality of life: First wave of a longitudinal study in Spain. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 65, e198–e203.CrossRefGoogle Scholar
- Gallant, M. P. (2013). Social networks, social support, and health-related behavior. In L. R. Martin & M. R. DiMatteo (Eds.), The Oxford handbook of health communication, behavior change, and treatment adherence (pp. 305–322). New York: Oxford University Press.Google Scholar
- Garcia-Retamero, R., Petrova, D., Arrebola-Moreno, A., Catena, A., & Ramírez-Hernández, J. A. (2016). Type D personality is related to severity of acute coronary syndrome in patients with recurrent cardiovascular disease. British Journal of Health Psychology, 14, 111–119.Google Scholar
- Hamm, C. W., Bassand, J. P., Agewall, S., Bax, J., Boersma, E., Bueno, H., et al. (2011). ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 32, 2999–3054.CrossRefPubMedGoogle Scholar
- Mitchell, P. H., Powell, L., Blumenthal, J., Norten, J., Ironson, G., Pitula, C. R., et al. (2003). A short social support measure for patients recovering from myocardial infarction: The ENRICHD social support inventory. Journal of Cardiopulmonary Rehabilitation and Prevention, 23, 398–403.CrossRefGoogle Scholar
- Park, H. W., Yoon, C. H., Kang, S. H., Choi, D. J., Kim, H. S., Cho, M. C., et al. (2013). Early-and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. International Journal of Cardiology, 169, 254–261.CrossRefPubMedGoogle Scholar
- Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., et al. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): Case-control study. The Lancet, 364, 953–962.CrossRefGoogle Scholar
- Sandín, B. (2003). El estrés: Un análisis basado en el papel de los factores sociales [Stress: An analysis based on social factors]. International Journal of Clinical and Health Psychology, 3, 141–157.Google Scholar
- Sanz, J., García-Vera, M. P., Espinosa, R., Fortún, M., & Vázquez, C. (2005). Adaptación española del inventario para la depresión de beck-II (BDI-II): 3. propiedades psicométricas en pacientes con trastornos psicológicos. Clínica y Salud, 16, 121–142.Google Scholar
- Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC), Steg, P. G., James, S. K., Atar, D., Badano, L. P., Blömstrom-Lundqvist, C., et al. (2012). ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 33, 2569–2619.CrossRefGoogle Scholar
- Taylor, S. E. (2011). Social support: A review. In H. Friedman (Ed.), Oxford handbook of health psychology (pp. 189–214). New York: Oxford University Press.Google Scholar
- van Melle, J. P., de Jonge, P., Spijkerman, T. A., Tijssen, J. G., Ormel, J., van Veldhuisen, D. J., et al. (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis. Psychosomatic Medicine, 66, 814–822.CrossRefPubMedGoogle Scholar
- Wills, T. A., & Ainette, M. G. (2012). Social networks and social support. In A. Baum, A. Revenson, & J. Singer (Eds.), Handbook of Health Psychology (pp. 465–492). New York: Psychology Press.Google Scholar