title: Low perceived social support and post-myocardial infarction prognosis in the enhancing recovery in coronary heart disease clinical trial: the effects of treatment.
abstract: OBJECTIVE
  In post hoc analyses, to examine in low perceived social support (LPSS) patients enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial (n = 1503), the pattern of social support following myocardial infarction (MI), the impact of psychosocial intervention on perceived support, the relationship of perceived support at the time of MI to subsequent death and recurrent MI, and the relationship of change in perceived support 6 months after MI to subsequent mortality.
  
  
  METHODS
  Partner status (partner, no partner) and score (<12 = low support; >12 = moderate support) on the ENRICHD Social Support Instrument (ESSI) were used post hoc to define four levels of risk. The resulting 4 LPSS risk groups were compared on baseline characteristics, changes in social support, and medical outcomes to a group of concurrently enrolled acute myocardial infarction patients without depression or LPSS (MI comparison group, n = 408). Effects of treatment assignment on LPSS and death/recurrent MI were also examined.
  
  
  RESULTS
  All 4 LPSS risk groups demonstrated improvement in perceived support, regardless of treatment assignment, with a significant treatment effect only seen in the LPSS risk group with no partner and moderate support at baseline. During an average 29-month follow-up, the combined end point of death/nonfatal MI was 10% in the MI comparison group and 23% in the ENRICHD LPSS patients; LPSS conferred a greater risk in unadjusted and adjusted models (HR = 1.74-2.39). Change in ESSI score and/or improvement in perceived social support were not found to predict subsequent mortality.
  
  
  CONCLUSIONS
  Baseline LPSS predicted death/recurrent MI in the ENRICHD cohort, independent of treatment assignment. Intervention effects indicated a partner surrogacy role for the interventionist and the need for a moderate level of support at baseline for the intervention to be effective.
authors.affiliation: Behavioral Cardiovascular Health and Hypertension, Columbia University School of Medicine, 622 West 168 Street, PH 9-941, New York, NY 10032, USA. mb2358@columbia.edu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: John
authors.initials: J
authors.lastname: Barefoot
authors.forename: Lisa
authors.initials: L
authors.lastname: Berkman
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Catellier
authors.forename: Susan
authors.initials: S
authors.lastname: Czajkowski
authors.forename: Patrice
authors.initials: P
authors.lastname: Saab
authors.forename: Marc
authors.initials: M
authors.lastname: Huber
authors.forename: Vicki
authors.initials: V
authors.lastname: DeLillo
authors.forename: Pamela
authors.initials: P
authors.lastname: Mitchell
authors.forename: Judy
authors.initials: J
authors.lastname: Skala
authors.forename: C Barr
authors.initials: CB
authors.lastname: Taylor
mesh_terms: D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D055502:Secondary Prevention; D012944:Social Support; D018454:Spouses / Q000706:statistics & numerical data; D016896:Treatment Outcome