title: The role of social support in health status and depressive symptoms after acute myocardial infarction: evidence for a stronger relationship among women.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.
authors.affiliation: Yale University, New Haven, CT 06520, USA.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Leifheit-Limson
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: Philip G
authors.initials: PG
authors.lastname: Jones
authors.forename: Donna M
authors.initials: DM
authors.lastname: Buchanan
authors.forename: Susmita
authors.initials: S
authors.lastname: Parashar
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D016009:Chi-Square Distribution; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016012:Poisson Distribution; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012944:Social Support; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services