Journal of Behavioral Medicine

, Volume 16, Issue 1, pp 45–63 | Cite as

Emotional support as a moderator of adjustment and compliance after coronary artery bypass surgery: A longitudinal study

  • James A. Kulik
  • Heike I. M. Mahler
Article

Abstract

The independent relationships of emotional support and marital status with posthospital adjustments following coronary artery bypass surgery (CABS) were examined longitudinally with an intake sample of 85 male patients. Follow-ups occurred at 1, 4, and 13 months after hospital release. Demographic characteristics (age, education) and cardiac status at the time of surgery (wall motion abnormalities) were controlled statistically. As anticipated, married patients were higher in emotional support throughout the follow-up period than were their unmarried counterparts, and both groups reported decreased support with time. Of more interest, higher support was significantly and independently predictive of better emotional status (lower anxiety, depression), perceived quality of life, and compliance with recommended behaviors (ambulating and not smoking). Support did not predict cardiac health (angina episodes, doctor visits for cardiac problems) during follow-up, however. There was no evidence that marital status, independent of emotional support, was related significantly to outcomes.

Key words

emotional support marital status coronary artery bypass surgery (CABS) adjustment compliance quality of life 

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References

  1. Aiken, L. H. (1975). Family adjustment following myocardial infarction: Implications for ambulatory medical care. Annual Meeting, American Sociological Association.Google Scholar
  2. American Heart Association (1991).1991 Heart and Stroke Facts, AHA, Dallas, TX.Google Scholar
  3. Bilodeau, C. B., and Hackett, T. P. (1971). Issues raised in a group setting by patients recovering from myocardial infarction.Am. J. Psychiat. 128: 105–110.PubMedGoogle Scholar
  4. Bramwell, L. (1986). Wives' expectations in the support role after husbands' first myocardial infarction.Heart Lung 15: 578–584.PubMedGoogle Scholar
  5. Braunwald, E. (1980). Assessment of cardiac performance. In Braunwald, E. (ed.),Heart Disease: A Textbook of Cardiovascular Medicine, W. B. Saunders, Philadelphia.Google Scholar
  6. CASS Principal Investigators and Their Associates (1983). Coronary Artery Surgery Study (CASS): Quality of life of patients randomly assigned to treatment groups.Circulation 68: 951–960.Google Scholar
  7. Chandra, V., Szklo, M., Goldberg, R., and Tonascia, J. (1983). The impact of marital status on survival after an acute myocardial infarction: A population-based study.Am. J. Epidemiol. 117: 320–325.PubMedGoogle Scholar
  8. Cobb, S. (1976). Social support as a moderator of life stress.Psychosom. Med. 38: 300–314.PubMedGoogle Scholar
  9. Cohen, J., and Cohen, P. (1975).Applied Multiple Regression/Correlation Analyses for the Behavioral Sciences, Erlbaum, Hillsdale, NJ.Google Scholar
  10. Cohen, S., and McKay, G. (1984). Social support, stress, and the buffering hypothesis: A theoretical analysis. In Baum, A., Taylor, S. E., and Singer, J. E. (eds.),Handbook of Psychology and Health, Vol. IV, Erlbaum, Hillsdale, NJ.Google Scholar
  11. Colletti, G., and Brownell, K. D. (1983). The physical and emotional benefits of social support: Application to obesity, smoking, and alcoholism. In Hersen, M., Eiser, R. M., and Miller, P. M. (eds.),Progress in Behavior Modification, Academic Press, New York.Google Scholar
  12. Costa, P. T., and McCrae, R. R. (1985). Hypochondriasis, neuroticism, and aging.Am. Psychol. 40: 19–28.PubMedGoogle Scholar
  13. Coyne, J. C., and DeLongis, A. (1986). Going beyond social support: The role of social relationships in adaptation.J. Consult. Clin. Psychol. 54: 454–460.PubMedGoogle Scholar
  14. Coyne, J. C., Wortman, C. B., and Lehman, D. R. (1988). The other side of support: Emotional overinvolvement and miscarried helping. In Gottlieb, B. H. (ed.),Marshalling Social Support; Formats, Processes, and Effects, Sage, Newbury Park.Google Scholar
  15. Croog, S. H. (1983). Recovery and rehabilitation of heart patients: Psychosocial aspects. In Krantz, D., Baum, A., and Singer, J. E. (eds.),Handbook of Psychology and Health: Cardiovascular Disorders and Behavior, Vol. III, Erlbaum, Hillsdale, NJ.Google Scholar
  16. Croog, S. H., and Levine, S. (1977).The Heart Patient Recovers, Human Sciences Press, New York.Google Scholar
  17. Folks, D. G., Blake, D. J., Fleece, L., Sokol, R. S., and Freeman, A. M. III (1986). Quality of life six months after coronary artery bypass surgery: A preliminary report.South. Med. J. 79: 397–399.PubMedGoogle Scholar
  18. Fontana, A. F., Kerns, R. D., Rosenberg, R. L., and Colonese, K. L. (1989). Support, stress, and recovery from coronary heart disease: A longitudinal causal model.Health Psychol. 8: 175–193.PubMedGoogle Scholar
  19. Funch, D. P., and Mettlin, C. (1982). The role of support in relation to recovery from breast surgery.Soc. Sci. Med. 16: 91–98.PubMedGoogle Scholar
  20. Gillis, C. L. (1984). Reducing family stress during and after coronary artery bypass surgery.Nurs. Clin. N. Am. 19: 103–111.Google Scholar
  21. Gove, W., Hughes, M., and Style, C. B. (1983). Does marriage have positive effects on the psychological well-being of the individual?J. Health Soc. Behav. 24: 122–131.PubMedGoogle Scholar
  22. Gundle, M. J., Reeves, B. R., Tate, S., Raft, D., and McLaurin, L. P. (1980). Psychosocial outcome after coronary artery surgery.Am. J. Psychiat. 137: 1591–1594.PubMedGoogle Scholar
  23. Horgan, D., Davies, B., Hunt, D., Westlake, G. W., and Mullerworth, M. (1984). Psychiatric aspects of coronary artery surgery: A prospective study.Med. J. Austral. 141: 587–590.PubMedGoogle Scholar
  24. House, J. S., and Kahn, R. L. (1985). Measures and concepts of social support. In Cohen, S., and Syme, S. L. (eds.),Social Support and Health, Academic Press, New York.Google Scholar
  25. House, J. S., Landis, K. R., and Umberson, D. (1988). Social relationships and health.Science 241: 540–545.PubMedGoogle Scholar
  26. Jenkins, C. D., Stanton, B., Klein, M., Savageau, J. A., and Harken, D. E. (1983a). Correlates of angina pectoris among men awaiting coronary by-pass surgery.Psychosom. Med. 45: 141–152.PubMedGoogle Scholar
  27. Jenkins, C. D., Stanton, B., Savageau, J. A., Denlinger, P., and Klein, M. (1983b). Coronary artery bypass surgery: Physical, psychological, social, and economic outcomes six months later.JAMA 250: 782–788.PubMedGoogle Scholar
  28. King, K. B. (1985). Measurement of coping strategies, concerns, and emotional response in patients undergoing coronary artery bypass grafting.Heart Lung 14: 579–586.PubMedGoogle Scholar
  29. Kolitz, K., and Pimm, J. B. (1984). Coronary bypass surgery: The role of the patient educator. In Pimm, J. B., and Feis, J. R. (eds.),Psychological Risks of Coronary Bypass Surgery, Plenum Press, New York.Google Scholar
  30. Kornfield, D. S., Heller, S. S., Frank, K. A., Wilson, S. N., and Malm, J. R. (1982). Psychological and behavioral responses after coronary artery bypass graft surgery.Circulation 66: (Suppl. III): 24–28.Google Scholar
  31. Kulik, J. A., and Mahler, H. I. M. (1987). The effects of preoperative roommate assignment on pre-operative anxiety and recovery from coronary-bypass surgery.Health Psychol. 6: 525–543.PubMedGoogle Scholar
  32. Kulik, J. A., and Mahler, H. I. M. (1989). Social support and recovery from surgery.Health Psychol. 8: 221–238.PubMedGoogle Scholar
  33. Levy, R. I., and Feinleib, M. (1980). Risk factors for coronary artery disease and their management. In Braunwald, E. (ed.),Heart Disease: A Textbook of cardiovascular medicine, W. B. Saunders, Philadelphia.Google Scholar
  34. Mahler, H. I. M., and Kulik, J. A. (1990). Preferences for health care involvement, perceived control, and surgical recovery: A prospective study.Soc. Sci. Med. 31: 743–751.PubMedGoogle Scholar
  35. Mayou, R., and Bryant, B. (1987). Quality of life after coronary artery surgery.Q. J. Med. 62: 239–248.PubMedGoogle Scholar
  36. Miller, P., Johnson, N. L., Wikoff, R., McMahon, M. F., and Garrett, M. J. (1983). Attitudes and regimen adherence of myocardial infarction and cardiac bypass patients.J. Cardiac Rehab. 3: 541–548.Google Scholar
  37. Murray, G. G., and Beller, G. A. (1983). Cardiac rehabilitation following coronary artery bypass surgery.Am. Heart J. 105: 1009–1018.PubMedGoogle Scholar
  38. National Heart, Lung, and Blood Institute. (1988). Percutaneous transliminal coronary angioplasty: A report from the registry.Am. J. Cardiol. 49: 2011–2020.Google Scholar
  39. Pearlin, L. I., and Johnson, J. S. (1977). Marital status, life-strains, and depression.Am. Social. Rev. 42: 704–715.Google Scholar
  40. Pearlin, L. I., Menaghan, E. C., Lieberman, M. A., and Mullan, J. T. (1981). The stress process.J. Health Soc. Behav. 1: 337–356.Google Scholar
  41. Peduzzi, P., and Hultgren, H. N. (1979). Effect of medical vs. surgical treatment on symptoms in stable angina pectoris: The Veterans Administration cooperative study of surgery for coronary arterial occlusive disease.Circulation 60: 888–899.PubMedGoogle Scholar
  42. Polister, P., and Cunico, E. (1988).Social-economic Factbook for Surgery, Socioeconomic Affairs Department, American College of Surgeons.Google Scholar
  43. Sackett, D. L. (1979). A compliance practicum for the busy practitioner. In Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore.Google Scholar
  44. Sarason, B. R., Sarason, I. G., Hacker, T. A., and Basham, R. B. (1985). Concomitants of social support: Social skills, physical attractiveness, and gender.J. Person. Soc. Psychol. 49: 469–480.Google Scholar
  45. Schaefer, C., Coyne, J., and Lazarus, R. (1981), The health-related functions of social support.J. Behav. Med. 4: 381–406.PubMedGoogle Scholar
  46. Silver, R., and Wortman, C. (1980). Coping with undesirable life events. In Garber, J. and Seligman, M. E. P. (eds.),Human Helplessness, Academic Press, New York.Google Scholar
  47. Veit, C. T., and Ware, J. E. (1983). The structure of psychological distress and well-being in the general population.J. Consult. Clin. Psychol. 51: 730–742.PubMedGoogle Scholar
  48. Wallston, B. S., Alagna, S. W., DeVellis, B. M., and DeVellis, R. F. (1983). Social support and physical health.Health Psychol. 2: 367–391.Google Scholar
  49. Waltz, M. (1986). Marital context and post-infarction quality of life: Is it social support or something more?Soc. Sci. Med. 22: 791–805.PubMedGoogle Scholar
  50. Warner, W. L. (1960).Social Class in America: A Manual of Procedure for the Measurement of Social Status, Harper and Row, New York.Google Scholar
  51. Wegner, N. K., and Fletcher, G. F. (1986). Rehabilitation of the patient with atherosclerotic coronary heart disease. In Hurst, J. W., Logue, R. B., Rackley, C. E., Schlant, R. C., Sonnenblick, E. H., Wallace, A. G., and Wegner, N. K. (eds.),The Heart, McGraw-Hill, New York.Google Scholar
  52. Wishnie, H. A., Hackett, T. P., and Cassem, N. H. (1977). Psychological hazards of convalescence following myocardial infarction. In Moos, R. H. (ed.),Coping with Physical Illness, Plenum Press, New York.Google Scholar
  53. Wortman, C. B., and Conway, T. L. (1985). The role of social support in adaptation and recovery from physical illness. In Cohen, S., and Syme, S. L. (eds.),Social Support and Health, Academic Press, New York.Google Scholar
  54. Zung, W. W. K. (1965). A self-rating depression scale.Arch. Gen. Psychol. 12: 63–70.Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • James A. Kulik
    • 1
  • Heike I. M. Mahler
    • 1
    • 2
  1. 1.Department of Psychology, 0109University of CaliforniaSan Diego, La Jolla
  2. 2.California State UniversitySan Marcos

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