Wednesday, December 21, 2016

Marital History Linked to Survival After Stroke

Interview with Matthew E. Dupre, Ph.D. Duke University
What is the background for this study? What are the main findings?
Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke. We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses. What should readers take away from your report?

Response: This study adds to a growing body of research showing how our social relationships can have immediate and lasting consequences for our health. Based on our findings, it’s important for people to understand that their marital history can impact their recovery following a serious health event such as a stroke. In particular, those who have been divorced or widowed more than once should consider talking to their health care provider about ways to possibly reduce their risks and take steps to improve their prospects of long-term survival. What recommendations do you have for future research as a result of this study?
Response: Our study was unique in that we took into account a wide range of suspected mechanisms that may have contributed to the associations. However, many of the associations remained largely unchanged. Somewhat unexpectedly, we found that factors such as income, health insurance, depressive mood, and a variety of health behaviors did not fully account for the risks associated with a history of marital loss. It may be that the acute and chronic stress related to the loss of a spouse may have played a role—particularly among those with multiple marital losses. We also suspect that marital instability may have had negative consequences for one’s medication adherence, healthcare utilization, and other behaviors for disease management that may have impeded recovery. We clearly need more research to fully understand what may be underlying these associations. Is there anything else you would like to add?

Response: More research is needed to know the full implications of these findings. We recognize that one’s marital background is not a modifiable risk factor like diet or exercise; however, we hope that this study brings a greater awareness of these risks and encourages health care providers to better recognize and tailor treatment for patients who may be particularly susceptible to dying after having a stroke. For instance, those who never marry or are without a spouse may benefit from resources to improve their social support, which we know improves the utilization of rehabilitative services, medication adherence, and changes in unhealthy behaviors. More research is needed, however, to know the full implications of our findings and to identify possible avenues of intervention. Thank you for your contribution to the community.
Marital History and Survival After Stroke
Matthew E. Dupre, Renato D. Lopes
Journal of the American Heart Association. 2016;5:e004647
Originally published December 14, 2016