Spouses of people who have a sudden heart attack are at increased risk for depression, anxiety or suicide after the event, according to a new study from Denmark that highlights family members may also need care when their loved ones suffer a heart attack, even when they survive it.

The researchers, who write about their study in a report published online on 21 August in the European Heart Journal, found that in the twelve months following the loss of a partner due to a heart attack, the surviving spouse is three times more likely to be taking antidepressant medication, compared to the year before the event.

They suffer more than spouses of people who die from, or survive, other conditions, and even those whose partners survive a heart attack are 17% more likely to be on antidepressants, they found.

The study, the first to look into these risks and compare them with those of people whose partners die from or survive other conditions, also found that men were at higher risk for depression and suicide after their wives survived or died from an acute myocardial infarction (AMI) than women.

The first author of the report is Emil L. Fosbøl, who currently works as a cardiologist in Copenhagen, Denmark. At the time of the study, he was in the United States, working as a cardiology research fellow at Duke Clinical Research Institute, Duke University Medical Center, North Carolina.

For their investigation, Fosbøl and colleagues in the US and Denmark used data from Danish registries, including the National Civil Status Registry that shows people’s marital status.

They compared 16,506 spouses of people who died from acute heart attack (AMI) between 1997 and 2008 with 49,518 spouses of people who died from causes unrelated to AMI.

They also examined data from 44,566 partners of people who survived heart attacks and matched and compared them with those of 131,563 spouses of patients admitted to hospital with non-fatal conditions unrelated to heart attacks.

In all cases, they looked at the use of medication to treat depression and anxiety before and up to 12 months after the event, plus data records of contact with the health system for depression and suicide.

The results showed that:

  • More than three times the number of people whose partners died from a heart attack (AMI) were taking antidepressants in the 12 months after the event compared with the 12 leading up to it.
  • Spouses of patients who did not survive an AMI also had an increased risk for depression and suicide.
  • Nearly 50 times as many spouses used a benzodiazepine (for treating anxiety) after the event compared to before.
  • For people whose spouse survived an AMI (compared with a non-AMI hospitalization) there was a much higher use of medication to treat depression or anxiety.
  • Male spouses of fatal and non-fatal AMI patients had a higher increased risk for depression than female spouses.

The researchers conclude:

“Spouses of those who experience AMIs – both fatal and non-fatal – are at elevated risk for psychological consequences; therefore, the care needs of AMI patients and their spouses need to be considered.”

The authors suggest it is the sudden and unexpected nature of an AMI that has the more extreme effect on the spouse. The psychological impact of such a huge and sudden loss is similar to post-traumatic stress disorder (PTSD).

“If your partner dies suddenly from a heart attack, you have no time to prepare psychologically for the death, whereas if someone is ill with, for example, cancer, there is more time to grow used to the idea,” said Fosbøl.

The public health implications of the study could be significant: more than 7 million people worlwide every year experience an AMI, and 16% of them die within a month of the event.

“This could mean that around 11,000 people would be likely to start antidepressants after a spouse’s non-fatal AMI, and 35,000 after their spouse died from an AMI,” said Fosbøl.

And, although suicide rates were low, we could expect approximately 1,400 people to take their own life in the year following a spouse’s death from a heart attack, he added, noting this is a major public health issue that doctors and policy makers seem largely unaware of.

“I think the most important finding of this study is that the system needs to consider the care needs for spouses too, not only when a patient dies from an AMI, but also when the patient is ‘just’ admitted to hospital with an AMI and survives,” said Fosbøl.

He and his colleagues say there don’t seem to be any provisions to spot spouses at risk and put in place preventive measures such as screening for depression and provide support such as grief and bereavement counselling.

Fosbøl called for further research into the effectiveness of targeted interventions to prevent depression in the spouses.

“I believe that treatment of an acute event also should include screening the spouse for possible psychological effects and a plan should be in place for how to take care of this, if indeed the spouse is severely affected,” he urged.

Other experts agree. Maureen Talbot is a Senior Cardiac Nurse for the British Heart Foundation. She told the press:

“A heart attack can impact the whole family and this study emphasises the importance of caring for the partners of heart attack sufferers.”

“We know that people can feel anxious or helpless when a loved one has a heart attack. It is essential they receive the emotional and practical support they need during this often traumatic time,” she added.

Written by Catharine Paddock PhD