Conflict With Close Family Can Trigger Unhealthy Levels Of Stress And Depression Among Heart Disease Patients

March 26, 1998

NEW ORLEANS -- Hostility and conflict with close family members can trigger unhealthy stress levels among heart disease patients, diminishing the benefit of having family support, a research team at Duke University Medical Center has concluded.

The results suggest that social support, which usually helps reduce stress and feelings of depression after hospitalization for heart disease, may actually increase stress if relationships are stormy. These findings are particularly important given that stress and depression now have been shown to be associated with poorer prognosis for heart disease patients. "We know the importance of exercise, healthy diet and smoking cessation in preventing recurrence of heart attack," said Dr. Redford Williams, director of behavioral research at Duke and the study's lead investigator. "It's time to recognize that emotional stress can be just as damaging. This suggests we need a new set of clinical approaches to managing heart disease. It is possible to help people learn simple ways to resolve conflict."

The finding, part of a study conducted among 290 coronary artery disease patients at Duke, was presented by Duke research fellow Beverly Brummett on March 26 at the Society of Behavioral Medicine's annual meeting in New Orleans. The findings are part of the National Institutes of Health funded "Moderators of Social Support (MOSS)" study. Other contributors were Duke researchers John Barefoot, Hayden Bosworth, Nancy Clapp-Channing, Russell Harwood, Ilene Siegler and Dr. Daniel Mark.

In a related study, the researchers showed that hostile behavior reduced social support and may have further contributed to feelings of depression and stress in heart disease patients after hospital discharge. That finding was presented at the American Psychosomatic Society meeting earlier this month.

In that study, researchers studied 560 coronary artery disease patients following hospitalization for diagnostic angiography, a procedure to determine the extent of obstruction in coronary arteries. Researchers administered questionnaires while patients were hospitalized and again one month later, once patients had gone home. Researchers assessed the level of social support each patient had and their level of hostility. Patients with less social support were more likely to be depressed one month after release from the hospital.Indeed, studies conducted at Duke and elsewhere in recent years have shown depression and stress can increase the risk of future cardiac events -- heart attack, surgery or death -- in heart disease patients.

"What we found in these studies is a constellation of risk factors that contribute to feelings of depression and stress," Williams said . "Hostility contributes to increased conflict, which in turn leads to social isolation.

Williams suggests administering questionnaires to heart disease patients to determine the level of conflict, hostility and stress in their lives, a simple procedure Duke physicians have employed for many years to assess stress level.

For patients at high risk for depression -- socially isolated people with few emotional supports -- he suggests offering structured conflict resolution training.

One such approach is "dialoging," in which the two parties in conflict take turns speaking for five minutes without being interrupted. At the end of the allotted time, the listener summarizes what the speaker has said without criticizing.

"Dialoging has been shown to be an effective structured way of discussing issues that helps keep emotions from getting out of hand," Williams said . "It's a way of understanding the other person's point of view, of empathizing with them."

Duke University Medical Center

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