title: Social support and the consequences of heart failure compared with other cardiac diseases: The contribution of support received within an attachment relationship.
abstract: BACKGROUND
  Interpersonal support is protective in heart disease, but sources of support and the quality of support may change over time, especially with aging and disease progression.
  
  
  OBJECTIVE
  To determine if support received within an attachment relationship with a spouse is more protective than other types.
  
  
  METHODS
  Subjects were sex- and age-matched cardiac outpatients with (n=40) or without (n=43) heart failure; they were studied with an observer-rated measure of attachment and self-report measures of other variables.
  
  
  RESULTS
  Having heart failure was associated with more depressive symptoms and illness intrusiveness. Although perceived social support did not differ in people with or without heart failure, those with heart failure had a spouse as the primary source of attachment functions less frequently than those without heart failure (50% vs 79%; P=0.006). Not having a spouse as the main provider of attachment functions was a partial mediator of the relationship between disease type (heart failure or no heart failure) and depressive symptoms (β=-0.24, t=-2.2; P=0.03) and deficits in non-attachment support made a further independent contribution (β=-0.24, t=-2.4; P=0.02). Neither perceived social support nor having a spouse serving attachment needs made a significant contribution to illness intrusiveness.
  
  
  CONCLUSIONS
  Having someone other than a spouse to provide attachment support is more common in cardiac patients who have heart failure and is associated with an increased risk of depressive symptoms.
authors.affiliation: Department of Psychiatry, Mount Sinai Hospital, Room 915, Mount Sinai Hospital, 600, University Avenue, M5G 1X5 Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada. Electronic address: rmaunder@mtsinai.on.ca.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada; Behavioural Cardiology Research Unit, University Health Network, Toronto, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Nolan
authors.affiliation: Department of Psychiatry, Mount Sinai Hospital, Room 915, Mount Sinai Hospital, 600, University Avenue, M5G 1X5 Toronto, Ontario, Canada.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Cardiology, North York General Hospital, Toronto, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: James
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Cardiology, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Newton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011379:Prognosis; D012307:Risk Factors; D012944:Social Support; D018454:Spouses / Q000523:psychology*
keywords: Attachment relationship; Depressive symptoms; Heart failure; Illness intrusiveness; Insuffisance cardiaque; Intrusion de la maladie; Relation d’attachement; Social support; Soutien social; Symptômes dépressifs