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Big Numbers on Patients’ Hearts, Spouses’ Minds

Posted By Barry J. Jacobs, Tuesday, August 28, 2012

There has long been evidence that heart attack survivors suffer high rates of depression. A new landmark study—probably the largest ever undertaken in the field of families and illness—convincingly documents that the mental health of the well spouses of heart attack survivors and victims is greatly affected as well.

Conducted by an American- Danish team led by Emil L. Fosbal, MD, PhD, a research fellow at Duke University, the study draws on epidemiological data from the Danish National Health Service registry for 1997-2008 on over 200,000 seriously ill patients and their spouses. Here is the link to the European Heart Journal article abstract. (We do not have permission to post the full text.) For a well crafted ABC News web article on the study, please see this link

The study’s main finding is that spouses of fatal and non-fatal heart attack patients have significantly higher rates of depression, antidepressant and benzodiazepine use, and suicide after the medical event than spouses of patients with other life-threatening conditions. The study’s authors’ main conclusions are that a sudden medical event is more psychologically harmful to spouses than grieving a progressive illness and that all spouses of heart attack sufferers need to be screened for emotional distress.
Dr. Barry J. Jacobs
The sudden catastrophe upends life’s desultory idyll and shatters normal family life.

In my opinion, this research article should become a mainstay of MedFT teaching and policy-making for several reasons:

  • The sheer number of patients and spouses involved in this study lends awesome power to the argument propounded in our July 3 blog post by Theodora Ooms and Jana Staton, entitled "I’m Not Her Caregiver. I’m Her Husband,” that conjugal bonds greatly impact health. Healthcare treatment of many medical conditions requires a marriage-centered, if not family-centered, approach
  • There is abundant evidence here that the psychological issues caused by sudden medical events—e.g., heart attack, traumatic brain injury, stroke—are of a different kind and intensity than those that stem from the slow, debilitating grind of dementia or MS care. Obviously, both can undermine the quality of a marriage. But the sudden catastrophe upends life’s desultory idyll and shatters normal family life. This study’s authors liken the spousal effects of a heart attack to Post-Traumatic Stress Disorder. Whether or not the well spouses meet criteria for that diagnosis, they are clearly stripped of their sense of safety. They don’t recover easily. They rue the present and dread the future.
  • The study gives credence to three tenets of marriage-centered care: Spouses should be routinely screened for depression and anxiety by physicians soon after patients’ sudden medical events. Psychopharmacological and psychotherapeutic treatment should be offered. Well spouses should be encouraged by healthcare professionals to seek support for themselves rather than just selflessly tending to patients’ demands.
  • The need is evident for psychotherapists who specialize in addressing the emotional and existential reactions of the spouses of cardiac patients. There are cardiac psychologists working in transplant centers currently who assess patients’ psychological readiness for heart transplant surgery but pay scant attention to those patients’ husband and wives. Medical family therapists are ideally trained to help patients’ spouses recover from the shock of heart attacks so that they don’t wind up becoming secondary psychological victims.

Barry J. Jacobs, Psy.D. is the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program and the author of The Emotional Survival Guide for Caregivers (Guilford, 2006). He is also the national spokesperson on family caregiving for the American Heart Association.

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