Psychology Research and Behavior Management (Nov 2022)
The Causal Effects of Anxiety-Mediated Social Support on Death in Patients with Chronic Heart Failure: A Multicenter Cohort Study
Abstract
Jingjing Yan,1 Jing Tian,1,2 Hong Yang,1 Gangfei Han,2 Yanling Liu,1 Hangzhi He,1 Qinghua Han,2 Yanbo Zhang3,4 1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China; 2Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 3Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People’s Republic of China; 4Shanxi University of Chinese Medicine, Taiyuan, People’s Republic of ChinaCorrespondence: Yanbo Zhang, Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, No. 56 South Xinjian Road, Taiyuan, Shanxi Province, 030001, People’s Republic of China, Tel +86 3543985051, Email [email protected] Qinghua Han, Department of Cardiology, The First Hospital of Shanxi Medical University, No. 85 South Jiefang Road, Taiyuan, Shanxi Province, 030001, People’s Republic of China, Tel +86 3100113031, Fax +86 3514867146, Email [email protected]: Chronic heart failure (CHF) affects more than 3.8 million people worldwide. There is a paucity of studies focusing on psychosocial issues in CHF patients. This study aimed to investigate the association of social support, mental adjustment and death to exploring whether mental adjustment could mediate the relationship.Methods: From May 2017 to June 2021, we conducted a multicenter clinical study to collect 1552 patients data. The Patient Report Outcome (PRO) scale were disseminated to collect information in the physical, psychological, social and therapeutic domains of patients. Marginal structural model was used to investigate the association of social support and CHF death, and the role of mental adjustment in their mediation.Results: The direct effect of social support accounted for 44.76% of the total effect. High social support (≥ 14 points) reduced mortality by 46.3% (RR=0.537, P=0.027), medium social support (11– 14 points) reduced mortality by 45.3% (RR=0.547, P=0.042). Anxiety (effect percentage: 24.63%) and appetite-sleep quality (effect percentage: 30.61%) played a mediating role between social support and death in CHF patients. In women, aged > 75 years, divorced or widowed patients were most prone to anxiety due to inadequate support (RR=0.519, P=0.019; RR=0.403, P=0.002; RR=0.413, P=0.041). Family care and socioeconomic assistance significantly reduced the risk of death (RR=0.689, P=0.040; RR=0.584, P=0.012).Conclusion: Social support can reduce patient mortality, especially family care and social economic assistance. The elderly, female, divorced or widowed patients are more likely to cause mental illness due to inadequate social support.Keywords: chronic heart failure, social support, marginal structural model, mediation analysis
