Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study

Astrid Suchy-Dicey, Harry Eyituoyo, Marcia O'Leary, Shelley A Cole, Aminata Traore, Steve Verney, Barbara Howard, Spero Manson, Dedra Buchwald, Paul Whitney, Astrid Suchy-Dicey, Harry Eyituoyo, Marcia O'Leary, Shelley A Cole, Aminata Traore, Steve Verney, Barbara Howard, Spero Manson, Dedra Buchwald, Paul Whitney

Abstract

Purpose: Our study examined psychosocial risk and protective features affecting cardiovascular and mortality disparities in American Indians, including stress, anger, cynicism, trauma, depression, quality of life, and social support.

Methods: The Strong Heart Family Study cohort recruited American Indian adults from 12 communities over 3 regions in 2001-2003 (N = 2786). Psychosocial measures included Cohen Perceived Stress, Spielberger Anger Expression, Cook-Medley cynicism subscale, symptoms of post-traumatic stress disorder, Centers for Epidemiologic Studies Depression scale, Short Form 12-a quality of life scale, and the Social Support and Social Undermining scale. Cardiovascular events and all-cause mortality were evaluated by surveillance and physician adjudication through 2017.

Results: Participants were middle-aged, 40% male, with mean 12 years formal education. Depression symptoms were correlated with anger, cynicism, poor quality of life, isolation, criticism; better social support was correlated with lower cynicism, anger, and trauma. Adjusted time-to-event regressions found that depression, (poor) quality of life, and social isolation scores formed higher risk for mortality and cardiovascular events, and social support was associated with lower risk. Social support partially explained risk associations in causal mediation analyses.

Conclusion: Altogether, our findings suggest that social support is associated with better mood and quality of life; and lower cynicism, stress, and disease risk-even when said risk may be increased by comorbidities. Future research should examine whether enhancing social support can prospectively reduce risk, as an efficient, cost-effective intervention opportunity that may be enacted at the community level.

Keywords: Cardiovascular disease; Depression; Mortality; Quality of life; Social support; Stress.

Conflict of interest statement

Declarations

Conflict of interest The authors have no conflicts to report.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Figures

Fig. 1
Fig. 1
Distributions of neuropsychological and psychosocial measures among American Indian adults from the Strong Heart Family Study (2001–2003). Legend: Histograms showing distributions of psychosocial measures, based on frequency. Measures include Cohen Perceived Stress Scale (PSS), Spielberger anger expression (AX) subscales, Cook-Medley cynicism scale, PTSD scale, Centers for Epidemiologic Studies Depression (CES-D) scale, Short Form 12 (SF) a quality of life scale, and Social Support and Social Undermining (SS/U) scale. Higher PSS scores connote higher perceived degree of life stress; higher AX-Out scores more likelihood to express anger outward; higher AX-In scores more likelihood to hide anger; higher AX-Control scores greater ability to control anger; higher Cook-C scores greater degree of cynical views or perspectives; higher PTSD score more symptoms related to traumatic experience; higher CES-D scores more symptoms of depression; higher SF-12 scores worse quality of life; higher emotional, instrumental, and total support scores greater degree of social support; higher criticism and isolation scores lower degree of social support.
Fig. 2
Fig. 2
Standardized Pearson product-moment correlation coefficient heatmap among neuropsychological and psychosocial measures among American Indian adults from the Strong Heart Family Study (2001–2003). Legend: Heatmap of Pearson correlation coefficients among standardized neuropsychological and psychosocial measures. Red indicates high degree of positive correlation and blue indicates high degree of negative correlation (inverse); with strength of coloration corresponding to coefficient indicated in legend (right). Variables all standardized (z-scored) to allow cross-comparisons. Measures include Cohen Perceived Stress Scale (PSS), Spielberger anger expression (AX) subscales, Cook-Medley cynicism scale, PTSD scale, Centers for Epidemiologic Studies Depression (CES-D) scale, Short Form 12 (SF) a quality of life scale, and Social Support and Social Undermining (SS/U) scale.

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