Psychosocial Effects of Acute Cardiovascular Events: Spousal Depression, Anxiety and Suicide After Myocardial Infarction

Cardiovascular events can have far reaching impacts.  Certainly the patients having the events are clearly affected in a life-changing way.  Patients are prescribed new medicines, are asked to make lifestyle changes and alter work and exercise habits.  However, families and loved ones are also greatly affected when cardiovascular disease strikes a spouse.  Most often, the focus is on the patient suffering the event and the spouse is left to worry and deal with fear and other emotions on their own.

Much has been written in the past about the effects of the death of a spouse on the emotional well being of the surviving family members.  As recently as this year, a study in Circulation examined the risk of death and MI in individuals following the death of a spouse or loved one.  These investigators found a significant increased risk (21 fold) of myocardial infarction (MI or heart attack) in the surviving spouse in the first 24 hours following the death during periods of intense grief.  To date, no one has directly examined the impact of specific cardiovascular events such as MI on the emotional well being of loved ones.  This week the European Heart Journal  published an interesting study on the effects that heart attacks (myocardial infarction or MI)  have on the emotional well being of spouses of patients.  The investigation evaluated over 16,000 spouses of patients suffering both fatal and non-fatal MI over an 11 year period.  Spouses of patients who suffered either fatal or non-fatal cardiac events were more likely to have anti-anxiety (benzodiazepines) or antidepressants prescribed.  In the group of patients that suffered from fatal heart attacks, these spouses had increased rates of depression and suicide as compared to control.  This study highlights another aspect of post MI care that providers must consider–the care of the family and spouse.  Attention must be paid to the individuals suffering alongside the affected heart attack patient.

Grief and anxiety are common reactions to illness and death in a close family member.  As providers we must be aware of the potentially serious negative impacts these intense emotions may have on those closest to the patient.  Athough we are certainly charged with caring for the patient, we must remain aware of family needs as well.

Here are my thoughts:

1. Communicate: Communication with family throughout the illness or event is of paramount importance.  Make every effort to provide information and insight to the spouse and other family members.  If a negative outcome is possible do your best to talk about these possibilities

2. Provide support:  When speaking with the family, make sure that you are able to offer emotional support.  Let them know that although you are clinically objective and working for the patient’s best interest, that you CARE.  Empathy is critical. Make sure that you alert appropriate support staff such as clergy, social workers, and case managers to visit with families of critically ill patients.

3. Follow up and Process:  Often when a spouse is lost to either a chronic or an acute illness or event, closure helps with emotional healing.  I believe it is important to provide support to the family in the days or weeks following a death or major cardiovascular event.  Schedule an appointment in the office to meet with the surviving spouse.  If you suspect depression, anxiety or other emotional disturbances, contact that patient’s primary care provider and facilitate treatment.

Grief can be a powerful negative influence in our overall health.  Clearly, the trauma surrounding a heart attack or cardiovascular death can cause significant emotional upset.  In some cases, as demonstrated by the European Heart Journal  study, this upset can progress to significant anxiety, depression and even suicide.  As caregivers, we cannot underestimate the impact that significant medical events have on spouses and families.  We must strive to not only care for the patient experiencing the event but also attend to those who share the life journey with the patient as well.