Linda Casciaro stayed calm during the several hours her husband, Frank, spent in surgery after he'd had a major heart attack several months ago. She was devastated but knew she had to remain strong and upbeat not only for her husband but for her daughter and the rest of the family as well. It was only in the days and weeks after her husband came home from the hospital that she found herself frequently dissolving into tears.
"That's when I started to feel overwhelmed and anxious," she says. "It seemed like his life was totally in my hands."
A new European Heart Journal report suggests that Casciaro's experience is by no means unique. In an investigation of more than 200,000 people, American and Danish researchers found the spouses of those who experience a sudden heart attack – what doctors call an acute myocardial infarction, or AMI – have an increased risk of depression, anxiety and suicide afterward, even if their partner survives. And they tend to suffer more psychologically than the partners of people who have other serious medical conditions.
More than three times the number of people whose significant other died from a sudden cardiac attack were using antidepressants in the year afterward, compared to the year before, the study found. Additionally, nearly 50 times as many of the spouses were taking a benzodiazepine, a class of drug used to treat anxiety. Men were more susceptible to depression and suicide than women, and partners experienced the same level of mental anguish, whether or not they were married.
"Those whose spouse survived an AMI had a 17 percent higher use of antidepressants after the event, whereas spouses of patients surviving some other non-AMI related condition had an unchanged use of antidepressants compared to before," says Dr. Emil Fosbøl, the study's lead author.
Caregivers' Feelings Often Overlooked
Dr. Neica Goldberg, a national spokeswoman for the American Heart Association notes that her experience treating patients mirrors what the study has found. "For a long time, we've known that there are issues with the psychological health of both the patient who suffers a heart attack and their spouse," she says. "I've noticed it and patients report it."
Goldberg says it's common for doctors to overlook how a caregiver is holding up because the caregiver is focused on prolonging the life of the patient. "We don't always take the time to focus on quality of life or what the family is going through," she points out.
Caregivers are often reluctant to talk about their own feelings because it's their partner who is sick and in need of immediate attention. Personal problems tend to come up in the context of their spouse's illness. For example, Goldberg says, a partner will take her aside to ask whether the patient can climb stairs, walk up hills or return to sexual activity. "That gives me the opportunity to ask about how they're doing and whether or not they need anything," she says.
Goldberg also makes sure that close family members are present when she speaks to patients about their condition to ensure everyone has an opportunity to ask questions and talk about all the issues, including their own.
Even if they are aware the significant other of a patient is depressed or anxious, cardiologists can't prescribe medication for them. But Goldberg says the doctor can and should recommend therapy.
Casciaro went to see a therapist after her husband got sick and found it immensely helpful. "I believe speaking to a professional was extremely important for both of us," she says.
Dorree Lynn, a therapist in private practice in Washington, D.C., and Florida has treated numerous spouses of heart attack victims and has found they benefit from close monitoring by a therapist as well as professional and family support. She works with a prescribing physician to offer medication and strongly suggest joining some form of group counseling.
"Never be isolated. Reach out or make sure family and friends are there for support. Hospitals offer support groups too so take advantage," she urges.
Although the study found more partners of heart attack patients committed suicide than the partners of those who suffered from other major illnesses, Lynn says that from her experience, suicide is not typically a major worry. The number of suicides in the study was relatively small.
It's not entirely clear why heart attacks hit spouses harder emotionally than other types of illness but the study's authors speculate their abrupt nature may be a contributing factor. Many patients go from being completely healthy to very sick in seconds--and many die. The majority of other diseases come on with a warning.
This is the first study to show how spouses of heart attack patients fare emotionally compared to spouses of those who are otherwise critically ill. Fosbøl believes the findings are significant because nearly seven million people worldwide experience a heart attack every year and there are few mechanisms in place to support their significant others.
"I would like to see a more formal way of screening spouses for depression in relation to the event, but also subsequently. A standardized program could potentially prevent many spouses from being depressed or taking their own lives," he says. "As a minimum, persons involved with patient care should be aware of the spouse and their mental reactions after a life-altering event such as an AMI."