The Role of Perceived Social Support for Cardiac Patients and their Spouses in their Dyadic Coping with Bypass Surgery

Oral presentation at the 12th Conference of the European Health Psychology Society EHPS in Vienna, 1998

Principal investigators of the study
Kerstin Schröder
Ralf Schwarzer

eMail: gschmitz@zedat.fu-berlin.de
WWW: http://userpage.fu-berlin.de/~gschmitz

Ladies and Gentlemen,

An increasing body of research on coping with stressful life events – such as coronary heart disease – has turned its attention towards a dyadic perspective rather than focusing on the individual only.

Imagine a person facing a serious illness: Would you expect close friends or a spouse not to be affected by this event?

Any serious event, for example bypass surgery, will not only change a person’s emotional or behavioral response, but also that of a close friend or a spouse. Moreover, this is a transactional relationship.

By example of a negative but well known pattern: The wife of a patient starts "taking over", insisting that the patient should take a rest, not drive the car, stay home or stay in bed etc..

The spouse’s good intentions can have a disasterous effect on the patient because the latter starts feeling helpless and ineffective, and he has no chance for any kind of mastery experience, which would be vital to his rehabilitation process.

In contrast, Ewart (1995) could show the beneficial effects of spouses taking part in the professional rehabilitation after bypass surgery. Spouses were able to obtain new information during the process and they changed their behavior and support accordingly.

Support, or better perceived social support, is also one of the key variables in the longitudinal study I would like to report about today.

This study of coronary artery bypass patients and their spouses had three waves of data collection.

First, 381 patients received a questionnaire shortly before surgery. 247 of them could be interviewed approximately five days after their surgery. Finally, 209 persons received a questionnaire six months after discharge from the cardiac ward of the Hospital.Berlin Charité

122 of their spouses received a smaller pre-surgery questionnaire as well, and 51 of them also filled out and returned the final questionnaire.

I would like to turn now to my major topic: The role of perceived social support in the process of recovery and readjustment after bypass surgery.

In general it was found: When patients felt well-supported, they also showed many other favorable characteristics, such as being less depressed, more vigorous, giving up less easily, feeling more in control, or showing more efficacious ways of coping. The same was true for spouses.

I would like you to keep this result in mind:

overall, feeling well supported means better adjustment and well-being.

ð Feeling well–supported means
better adjustment and well-being
for both patients and spouses.

This result is supported by negative associations found between patients’ perceived social support and their 'physical symptoms' – here by example of the lagged correlations – that show the beneficial influence of being supported: Patients who felt highly supported suffered from less physical symptoms even shortly before and shortly after their bypass surgery, as well as half a year later.

Lagged Associations between perceived social support and physical symptoms in Patients

Another measure are patients’ indicators of early recovery. They assessed the number of days it took a patient to do things for the first time after surgery again, like sitting up in bed, reading a book, or eating with good appetite.

Although these indicators have a reduced variance because they strongly depend on the physical condition after surgery, still a consistent correlational pattern with perceived support evolved.

Let me illustrate this in a bar chart that shows on the x–axis the number of days it took a patient – in this case – to read for the first time.

Patients living with a partner should be the majority for a small number of days (this is quick recovery), but the minority for a high number of days (meaning rather slow recovery). This pattern is found for all 11 indicators.

In short: Socially supported patients tend to recover more quickly after bypass surgery.

So far I have mainly talked about findings on patients. Now I will turn to associations between patients and relatives.

In 115 couples, patients who felt highly supported were associated with partners who expressed low fatigue, displeasure, and sadness on the Profile of Mood States POMS (German version), and who rather did not feel lonely.

In short: Patients who felt well-supported lived with spouses who were rather well-adjusted.

This is also true for longitudinal results: At Time 1, spouses high on perceived support and optimism and low on displeasure and loneliness were linked to patients who felt well-supported half a year later.

So the effect that well-supported patients lived with well-adjusted spouses is quite stable.

Coyne & Smith (1991, p. 405) found coping with myocardial infarction to be a "thoroughly dyadic affair". Let us now study the dyadic perspective in more detail.

Two groups of couples were computed:

One group consisted of couples both feeling well-supported, the second group containing little supported couples.

The next step was to look at mean differences in an ANOVA between those two groups. Many strong effects were found. Loneliness was yielding always the strongest effect.

This can be illustrated in a bar chart: Here you can see the mean differences by example of relatives’ ‘fatigue’ between the LoLo– and the HiHi–Group:

Spouses being part of a high–support couple suffered less from fatigue.

This table shows significant results for all variables:

Analyses of Variance for Group Membership of Support and Variables at Time 1

Among patient variables that made a significant contribution to distinguish between the two groups of support, you find apart from loneliness their general self-efficacy, their optimism, and their sadness.

Among spouses’ variables, apart from loneliness, the indicators of adjustment, POMS subscales fatigue and displeasure, made a contribution.

These results were partly replicated by discriminant analyses.

Two analyses were run: one only with patients’ variables, one only with relatives’ variables.

Since it is not very surprising that loneliness is the best discriminator between the groups of support, being almost the opposite construct, both analyses were run once more without loneliness.

Three patient variables explained 34% of the variance, the strongest being patients’ general self-efficacy with 22% of explained variance.

These three variables led to 71% correct classifications of group membership.

When using only relatives’ variables, even 41% of the variance could be accounted for and it resulted in correct classification for 75% of the couples. The strongest discriminator was spouses’ fatigue, accounting for 36% of the variance.

Just as a reminder: Fatigue was a major indicator of relatives’ adjustment. That this indicator accounts for more than one third of the differences between well– and little–supported couples seems to be rather strong evidence for the perspective of a dyadic coping process of couples coping with a serious illness.

Let me briefly sum up the results:

Summary

• High perception of support is linked to favorable characteristics and to good adjustment in patients and their spouses.

• Patients’ perceived support is linked to objective their physical symptoms and to their indicators of early recovery immediately after surgery.

• Well-supported patients are associated with well-adjusted spouses, even over the period of half a year.

• Little- and well-supported couples differed most strongly on loneliness, but also on patients’ general self-efficacy, and on spouses’ adjustment indicators.

• Discriminant analyses replicated: Best discriminators apart from loneliness, are patients’ general self-efficacy and relatives’ fatigue.

To conclude:

Conclusions

• Living in a high-support couple means good short–term and long–term adjustment in patients as well as in their spouses.

• High general self–efficacy of patients was linked to good adjustment; thus, a self–efficacy training might enhance the readjustment process.

• Since the impact of spouses’ adjustment on patients’ perception of support is strong, and since high support is linked to quick recovery and good adjustment in patients, it seems vital to help also spouses in their readjustment and to let them take part in the rehabilitation process.

Thank you very much for your kind attention.

Designed by Gerdamarie S. Schmitz
last update 12.09.96