The Causal Effects of Anxiety-Mediated Social Support on Death in Patients with Chronic Heart Failure: A Multicenter Cohort Study

Jingjing Yan; Jing Tian; Hong Yang; Gangfei Han; Yanling Liu; Hangzhi He; Qinghua Han; Yanbo Zhang

doi:10.2147/PRBM.S387222

The Causal Effects of Anxiety-Mediated Social Support on Death in Patients with Chronic Heart Failure: A Multicenter Cohort Study

Psychol Res Behav Manag. 2022 Nov 8:15:3287-3296. doi: 10.2147/PRBM.S387222. eCollection 2022.

Authors

Jingjing Yan¹, Jing Tian^{1

2}, Hong Yang¹, Gangfei Han², Yanling Liu¹, Hangzhi He¹, Qinghua Han², Yanbo Zhang^{3

4}

Affiliations

¹ Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China.
² Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
³ Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China.
⁴ Shanxi University of Chinese Medicine, Taiyuan, People's Republic of China.

Abstract

Background: 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; marginal structural model; mediation analysis; social support.

Grants and funding

This research is supported by a grant from the National Natural Science Foundation of China (grant no: 81872714, 82103958) and Shanxi Provincial Science and Technology Achievements Transformation Project (grant no: 201903D321104).