title: Social relations in women with coronary heart disease: the effects of work and marital stress.
abstract: BACKGROUND
  Studies have previously shown that psychosocial stress, related to both work and family, is associated with the increased risk of coronary heart disease (CHD) morbidity and mortality. The objective of this study was to examine how social relations are affected by marital stress and work stress in a population-based sample of Swedish women with CHD.
  
  
  METHODS
  Data was obtained from the Stockholm Female Coronary Risk Study, comprising 292 women aged 65 years or younger, with a mean age of 56 (SD=7) years admitted for an acute event of CHD and examined 3-6 months after hospitalization. Marital and work stress was assessed using the Stockholm Marital Stress Scale and the Swedish version of the Karasek demand-control questionnaire, respectively. Condensed versions of the Interview Schedule for Social Interaction (ISSI) and of Interpersonal Support Evaluation List (ISEL) were used to assess social relations and social support.
  
  
  RESULTS
  Marital stress was associated with less social integration (P<0.001), less appraisal support (P<0.001), a lower sense of belonging (P<0.01) and less tangible support (P<0.01) even after controlling for work stress. Adjustment for age, socioeconomic status (education and occupational status) did not alter these results significantly. Work stress did not show statistically significant effects on any of the measured social relations.
  
  
  CONCLUSIONS
  The present study showed that marital stress influenced women's social relations. These results suggest that marital stress needs to be further investigated not only as an independent but also as an interactive risk factor for women with CHD.
authors.affiliation: Preventive Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. may.blom@smd.sll.se
authors.forename: May
authors.initials: M
authors.lastname: Blom
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: Piroska
authors.initials: P
authors.lastname: Balog
authors.forename: Kristina
authors.initials: K
authors.lastname: Orth-Gomér
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Wamala
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology* / Q000401:mortality / Q000523:psychology*; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008393:Marriage / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012919:Social Behavior; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications* / Q000401:mortality / Q000523:psychology*; D013548:Sweden / Q000453:epidemiology