Abstract
Background: Given that approximately one-third of individuals with coronary artery disease (CAD) remain severely fatigued after completion the cardiac rehabilitation, it is necessary to identify reliable intervention targets aimed at reducing fatigue. Perceived social support is closely linked to health outcomes and depressive symptoms in individuals with CAD. However, to our knowledge, the relationship between subjective fatigue levels and social support in those with CAD has not been analyzed. Objective: We aimed to examine the associations between perceived social support and subjective fatigue levels in individuals with CAD with and without depression symptoms. Methods: This cross-sectional study was comprised of 1,036 participants with CAD (57±9years, 77% men) 1–2weeks after acute coronary syndrome (ACS). Participants completed the Hospital Anxiety and Depression scale (HADS), Multidimensional Fatigue Inventory-20 (MFI-20), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: In total, 12% (n=129) of study participants had elevated depression symptoms (HADS score≥8). In individuals with CAD and depressive symptoms, after adjustment for sex, age, New York Heart Association (NYHA) functional class, and anxiety, linear regression analyses showed significant inverse associations between higher social support from others and general, physical fatigue as well as reduced activity and motivation (p<0.001). Following the same method of statistical analysis and control in non-depressed individuals with CAD (88%), social support from family was inversely linked to mental fatigue (p’s<0.05). Similarly, social support from friends was significantly associated with lower general, physical, and mental fatigue as well as reduced activity, while social support from others was significantly associated with lower general and mental fatigue (p’s<0.001). The overall higher total support was linked with reduced motivation (p<0.05) in the depressed study participants, while there was lower general and mental fatigue (p<0.05) in non-depressed individuals. Conclusion: The results of this study suggest that fatigue and its features could be associated by the perceived social support in individuals with CAD following ACSs. While in individuals with CAD and depressive symptoms, greater subjective fatigue is associated with less perceived social support from others, higher levels of subjective fatigue in non-depressed individuals with CAD are significantly associated with reduced perceived social support from friends.
Highlights
Coronary artery disease (CAD) is one of the most common cardiovascular illness affecting people all over the world and is the leading cause of death in both developed and developing countries (Malakar et al, 2019)
Since major significant differences emerged in terms of anxiety, social support, and fatigue in those with and without markedly expressed depression symptoms, separate regression analyses were performed to emphasize possible group differences
While in individuals with CAD with markedly expressed depression symptoms higher levels of subjective fatigue are associated with mostly social support from others, higher levels of subjective fatigue in non-depressed individuals with CAD are significantly associated with mostly reduced social support from friends
Summary
Coronary artery disease (CAD) is one of the most common cardiovascular illness affecting people all over the world and is the leading cause of death in both developed and developing countries (Malakar et al, 2019). It is well established that perceived social support is closely linked to health outcomes in individuals with CAD. Considering the context, CAD is not an exception, since fatigue is a common disturbing symptom in individuals with this particular diagnosis, linked to poor cognitive performance (Burkauskas et al, 2017) and worse health related quality of life (Staniute et al, 2014). Given that approximately one-third of individuals with coronary artery disease (CAD) remain severely fatigued after completion the cardiac rehabilitation, it is necessary to identify reliable intervention targets aimed at reducing fatigue. Perceived social support is closely linked to health outcomes and depressive symptoms in individuals with CAD. To our knowledge, the relationship between subjective fatigue levels and social support in those with CAD has not been analyzed
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