I used to offer to sell to my non-Ukrainian friends the guest list from our big Ukrainian wedding. Imagine 450 names, all of whom were raised in a wonderful Slavic culture that knows what to do when hard times strike. No sooner do they hear of a friend or neighbour’s problems (like a family tragedy or a serious health crisis) – and they start pitching in to help. Such support often starts with baking, cooking and getting the casserole dishes lined up on the kitchen counter for imminent delivery to the freshly-stricken person’s fridge. Researchers know that having social support like this from others following a heart attack (or any serious health crisis) helps not only with physical recuperation, but also with emotional and psychological recovery, too. Yet virtually all published health research on the important quality-of-life issue of social support so far has been done on men.
White men, almost all of them seniors.
So lots of old white men studied, but very few women – and very few patients of either gender who were younger than 55 years of age. But the VIRGO study published in the Journal of the American Heart Association finally attempts to address this gap.(1) . . .
The patients participating in this research were 3,400 recent heart attack survivors under age 55 from both the U.S. and Spain who were assessed in hospital, and then followed up again one year after their cardiac events. To determine how individual social support affected later quality-of-life outcomes, each person was asked a number of questions based on a commonly-used social support assessment tool called ESSI (ENRICHD Social Support Instrument), such as:
- Is there someone available to whom you can count on to listen to you when you need to talk?
- Is there someone available to you to give you good advice about a problem?
- Is there someone available to you who shows you love and affection?
- Is there someone available to help with daily chores?
- Can you count on anyone to provide you with emotional support (talking over problems or helping you make a difficult decision)?
- Do you have as much contact as you would like with someone you feel close to, someone in whom you can trust and confide in?
- Are you currently married or living with a partner?
By the way, last time you were hospitalized, did any doctor or any nurse or any social worker or any janitor or anybody at all employed by your hospital ask you this list of questions before you were discharged?
Me neither . . .
The lead author of this study was Dr. Harlan Krumholz from Yale University School of Medicine, who explained:
“In this study of young patients with acute myocardial infarction (AMI – or heart attack), patients with low social support presented with poorer mental health functioning and more depressive symptoms at the time of AMI than patients with moderate/high social support.
“These differences across social support groups persisted at 12 months following AMI, which resulted in poorer 12‐month mental health and quality‐of‐life outcomes in patients with low social support.”
The authors of the JAHA study were also interested in studying female heart attack survivors under the age of 55. Here’s what they wrote:
“Young women may represent a group at particularly high risk of low social support.
“Although population‐based studies have found that both receiving and giving support decline as age increases, reports in the cardiac literature have generally shown lower levels of social support in young patients after heart attack.
“However, in all of these studies, the average age of patients was still over 60 years.”
It turns out, say the researchers, that almost nothing is known about the magnitude of social support in younger heart patients under 55. And although studies in the general population report larger and more varied social networks in women than in men, nearly all studies in cardiac populations have noted lower support in women no matter what their age.
How can this be? Researchers suggest that these gender differences may be the result of women’s roles as primary caretakers, prompting them to minimize the impact of their disease in order to avoid burdening others. Research in the general population has also shown that while older patients are more likely to rely on their immediate family for help, younger patients tend to include fewer family members but more friends and co-workers in their support networks. *See links below to online and virtual suppport groups available from WomenHeart: The National Coalition for Women With Heart Disease.
Younger people (both the ones who are patients as well as those who are those friends and co-workers now expected to provide social support to patients) may experience more stress from work, raising a family or social obligations – all of which may compromise their previously-established support structures.
(To test this theory, just try having a newborn baby and then watch your capacity to whip up casseroles for your sick friends evaporate . . .)
In fact, say the study authors, research has consistently shown that younger people require larger social networks than older people just to maintain a sense of well-being.
Research on social strain published in 200o in the Journal of Social and Personal Relationships similarly suggests that, while negative social exchanges are related to lower positive mood and life satisfaction for younger and middle-aged adults, the impact of such negative relationships is often less among older adults(2). For example, older adults may be able to ignore problems with their close social partners because they know that these relationships are also a source of emotional closeness and intimacy to them over time. These findings, say this study’s authors, may help to explain how older adults assess their social relationships more positively – even in the face of what appears to be lack of social support.
But when it comes to women and their heart disease diagnoses, there’s far more going on that just sitting around waiting for casserole deliveries from your social support networks. For example, as the JAHA study’s researchers add:
“Women may also receive less information about their cardiac disease and cardiac rehabilitation, and experience a lack of belief in their heart problems from providers.
“Thus, young women may be at increased risk of low social support both at the time of their heart attack and during the course of recovery, which may place them at higher risk of adverse outcomes.”
But wait. There’s more – and none of it is good news for women heart patients.
Although this JAHA study looked specifically at younger women, a Swedish study found that traditional gender-role patterns may also influence the social supports and recovery of all-age heart attack survivors – especially women.(3)
Authors of this study, published in the Journal of Advanced Nursing, wrote:
“Women survivors used a variety of coping strategies, and more often than men. Women minimized the impact of the disease, tended to delay in seeking treatment, and did not want to bother others with their health problems. Household activities were more important to them than to men. Men were more likely to involve their spouses in their recovery than women were.
“Women tended to report that they had less social support up to one year after a myocardial infarction compared with men.
“They received less assistance with household duties from informal caregivers. Men tended to report more support from their spouses than did women.”
(1) Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results rrom the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. Harlan Krumholz, Emily M. Bucholz et al. J Am Heart Assoc. 2014; 3: e001252.
(2) Social support and strain from partner, family, and friends: costs and benefits for men and women in adulthood. Walen HR, Lachman ME. J Soc Pers Relat. 2000; 17:5–30
(3) Myocardial infarction: gender differences in coping and social support. Marja-Leena Kristofferzon et al. Journal of Advanced Nursing. doi: 10.1046/j.0309-2402.2003.02815.x November 2003
Q: How did your social support circle help your own recovery?
- *WomenHeart: The National Coalition for Women With Heart Disease has a couple of support options that might help. One is their online support community, free to join, with over 28,000 other members worldwide, all women living with heart disease (including a topic subgroup called Young Survivors). They also offer virtual support groups, free to join, with regularly scheduled small groups of about 12 women participating by phone in one-hour support meetings led by trained facilitators, with meeting topics scheduled on Heart Failure, Atrial Fibrillation or Heart Disease in general.