What is the clinical evidence from this study?

Study design: Review. Population: Heart disease. Intervention: Social support and marital status vs. Low social support or unmarried status. Primary outcome: Cardiac prognosis and adverse outcomes.

January 1, 2013Open Access

Social support, depression, and heart disease: a ten year literature review

Key Result

Low social support, being unmarried, and depression are independent and significant risk factors for poor cardiac prognosis in patients with heart disease.

Structured PICO

Does low social support and depression increase poor prognosis in patients with heart disease?

Population

Patients with heart disease (including congestive heart failure, sudden cardiac arrest, acute myocardial infarction, and coronary heart disease) across 5 studies (3 prospective cohorts, 1 case-control, 1 RCT).

Intervention

Low social support, being unmarried, and depression

Comparator

High social support, being married, and absence of depression

Outcome

Poor cardiac prognosis (including mortality, morbidity, sudden cardiac arrest, and incident CHD)hard clinical

Depressive symptoms and the absence of social or marital support are significant, independent risk factors for poor prognosis in cardiac patients, highlighting the need for psychosocial assessment in cardiac rehabilitation.

Limitations

The majority of studies did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship.
Lack of adequate control groups in some included studies.
High gender imbalance in some included studies.
Use of a single-item scale to assess loneliness in one of the studies.

Abstract

BACKGROUND: Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease. However, little is known about the hypothetical relationship pattern between them. PURPOSE: The purposes of this narrative review are (1) to appraise the 2002-2012 empirical evidence about the multivariate relationship between depression, social support and health outcomes in patients with heart disease; (2) to evaluate the methodological quality of included studies. METHOD: PubMed and PsychINFO were searched for quantitative studies assessing the multiple effects of low social support and depression on prognosis outcomes in patients with heart disease. The following search terms were used: social relation(*), cardiac disease, support quality, relationship, and relational support. RESULTS: Five studies (three prospective cohort studies, one case-control study, and one randomization controlled trial) were selected and coded according to the types of support (social and marital). The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations. CONCLUSION: Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients.

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