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ORIGINAL ARTICLE |
From the Behavioral Medicine Research Center and the Department of Psychiatry and Behavioral Sciences (B.H.B., J.C.B., I.C.S., R.B.W.), Duke University Medical Center; the Outcomes Research and Assessment Group, Duke Clinical Research Institute (D.B.M., N.E.C.-C., B.L.L.), Duke University Medical Center; and Health Services Research and Development (H.B.B.), Durham Veterans Affairs Medical Center, Durham, North Carolina.
Address reprint requests to: Beverly H. Brummett, PhD, Duke University Medical Center, Box 2969, Durham, NC 27710. Email: brummett{at}acpub.duke.edu
OBJECTIVES: Social isolation has been linked to poor survival in patients with coronary artery disease (CAD). Few studies have closely examined the psychosocial characteristics of CAD patients who lack social contact.
METHODS: Social isolation was examined as a predictor of mortality in 430 patients with significant CAD. More isolated patients were compared with their less isolated counterparts on factors that might help explain the association between isolation and survival.
RESULTS: The mortality rate was higher among isolated individuals. Those with three or fewer people in their social support network had a relative risk of 2.43 (p = .001) for cardiac mortality and 2.11 (p = .001) for all-cause mortality, controlling for age and disease severity. Adjustments for income, hostility, and smoking status did not alter the risk due to social isolation. With the exception of lower income, higher hostility ratings, and higher smoking rates, isolated patients did not differ from nonisolated patients on demographic indicators, disease severity, physical functioning, or psychological distress. Isolated patients reported less social support and were less pleased with the way they got along with network members, but they did not report less satisfaction with the amount of social contact received.
CONCLUSIONS: Patients with small social networks had an elevated risk of mortality, but this greater risk was not attributable to confounding with disease severity, demographics, or psychological distress. These findings have implications for mechanisms linking social isolation to mortality and for the application of psychosocial interventions.
Key Words: social support networks • cardiac mortality.
Abbreviations: CAD = coronary artery disease; CES-D = Center for Epidemiologic Studies Depression Scale; CI = confidence interval; DASI = Duke Activity Status Index; ISEL = Interpersonal Support Evaluation List; MOSS = Mediators of Social Support; PSS = Perceived Stress Scale; RR = relative risk; SF-36 = SF-36 Health Survey.
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