Leifheit-Limson Erica C, Reid Kimberly J, Kasl Stanislav V, Lin Haiqun, Jones Philip G, Buchanan Donna M, Parashar Susmita, Peterson Pamela N, Spertus John A, Lichtman Judith H
Yale University, New Haven, CT 06520, USA.
Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):143-50. doi: 10.1161/CIRCOUTCOMES.109.899815. Epub 2010 Feb 16.
Prior studies have associated low social support (SS) with increased rehospitalization and mortality after acute myocardial infarction. However, relatively little is known about whether similar patterns exist for other outcomes, such as health status and depressive symptoms, and whether these patterns vary by sex.
Using data from 2411 English- or Spanish-speaking patients with acute myocardial infarction enrolled in a 19-center prospective study, we examined the association of SS (low, moderate, high) with health status (angina, disease-specific quality of life, general physical and mental functioning) and depressive symptoms over the first year of recovery. Overall and sex-stratified associations were evaluated using mixed-effects Poisson and linear regression, adjusting for site, baseline health status, baseline depressive symptoms, and demographic and clinical factors. Patients with the lowest SS (relative to those with the highest) had increased risk of angina (relative risk, 1.27; 95% confidence interval [CI], 1.10, 1.48); lower disease-specific quality of life (mean difference [beta]=-3.33; 95% CI, -5.25, -1.41), lower mental functioning (beta=-1.72; 95% CI, -2.65, -0.79), and more depressive symptoms (beta=0.94; 95% CI, 0.51, 1.38). A nonsignificant trend toward lower physical functioning (beta=-0.87; 95% CI, -1.95, 0.20) was observed. In sex-stratified analyses, the relationship between SS and outcomes was stronger for women than for men, with a significant SS-by-sex interaction for disease-specific quality of life, physical functioning, and depressive symptoms (all P<0.02).
Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.
先前的研究表明，社会支持水平低与急性心肌梗死后再住院率和死亡率增加有关。然而，对于其他结局，如健康状况和抑郁症状，是否存在类似模式，以及这些模式是否因性别而异，人们了解得相对较少。
我们使用了一项19中心前瞻性研究中2411名讲英语或西班牙语的急性心肌梗死患者的数据，研究了社会支持水平（低、中、高）与康复第一年的健康状况（心绞痛、疾病特异性生活质量、总体身体和心理功能）及抑郁症状之间的关联。使用混合效应泊松回归和线性回归评估总体及按性别分层的关联，并对研究地点、基线健康状况、基线抑郁症状以及人口统计学和临床因素进行了调整。社会支持水平最低的患者（相对于最高者）发生心绞痛的风险增加（相对风险，1.27；95%置信区间[CI]，1.10，1.48）；疾病特异性生活质量较低（平均差异[β]= -3.33；95%CI，-5.25，-1.41），心理功能较低（β= -1.72；95%CI，-2.65，-0.79），抑郁症状更多（β= 0.94；95%CI，0.51，1.38）。观察到身体功能有降低的非显著趋势（β= -0.87；95%CI，-1.95，0.20）。在按性别分层的分析中，女性社会支持水平与结局之间的关系比男性更强，在疾病特异性生活质量、身体功能和抑郁症状方面存在显著的社会支持水平×性别的交互作用（均P<0.02）。
在急性心肌梗死康复的第一年，社会支持水平较低与较差的健康状况和更多的抑郁症状相关，尤其是女性。
