Loss of a spouse to a myocardial infarction (MI) was associated with a significant risk for depression and psychotropic medication use by the surviving partner, a large Danish study found.
Compared with the year before the death of a spouse from an acute MI, during the subsequent year the overall incidence rate ratio (IRR) for use of an antidepressant was 3.30 (95% CI 2.97 to 3.68), according to Emil L. Fosbøl, MD, of Duke University.
In addition, during the month after the fatal MI, there was a notably high rate of benzodiazepine use by surviving spouses (IRR 46.4, 95% CI 42.2 to 50.9), the researchers reported online in the European Heart Journal.
The researchers acknowledged that causality cannot be inferred from this pre- and post-observational analysis. Nonetheless, Danish administrative registries used for this research provided a “unique dataset” and a chance to study the issues on a national scale.
Studies have shown that many patients who survive an MI develop depressive symptoms, and also that loss of a spouse in general is associated with adverse events in the surviving partner.
However, little is known about the effects specifically of MI – fatal or not – on the spouse, which could differ from many other causes of death because the event is largely unexpected.
To explore the spousal impact of MI, Fosbøl and colleagues analyzed data from the registries that included 4.6 million people, comparing factors associated with depression during the year before and after the event.
They identified 16,506 spouses of patients with fatal MI, matching them with 49,518 spouses of patients whose deaths were from other causes.
They also matched 44,566 spouses of patients who had a nonfatal MI with 131,564 spouses of patients who experienced a nonfatal major health event other than MI.
Among spouses of patients who died from an MI, antidepressant use peaked at 2 months after the death (IRR 5.72, 95% CI 4.85 to 6.74) and diminished by 1 year (IRR 2.20, 95% CI 1.71 to 2.82).
Antidepressant use also was increased following a non-MI death, although the degree of change in the year after the death was less than for MI-related death (IRR 2.21, 95% CI 2.08 to 2.34, P<0.0001 for interaction), the researchers reported.
For nonfatal events, a significant increase in the use of antidepressants was seen in the MI group (IRR 1.17, 95% CI 1.07 to 1.28), but not in the non-MI group (IRR 1.04, 95% CI 0.98 to 1.09, P=0.02 for interaction).
Spouses also had elevated risks for having contact with a hospital for treatment of depression during the year after fatal MI (IRR 2.79, 95% CI 2 to 3.89) and nonfatal MI (IRR 2.33, 95% CI 1.90 to 2.85).
Moreover, suicides were more common in spouses following MI deaths compared with deaths from other causes (0.24% versus 0.17%, P=0.07) and with nonfatal MI compared with other nonfatal events (0.06% versus 0.01%, P<0.0001).
Analysis according to age and gender determined that younger individuals had higher rates of antidepressant use (P=0.002 for interaction) and for use of benzodiazepines (P<0.0001 for interaction), while men had higher rates of all outcomes.
While previous research has demonstrated that the death of a spouse can have a negative influence on both health and life expectancy, this study adds to current knowledge by showing that the cause of death also is important.
“Specifically, those dying of an [acute] MI often die suddenly and unexpectedly. This acute loss appears to have a larger psychological impact on the spouse than a loss due to other causes,” the researchers observed.
They also estimated the impact of the annual seven million annual MIs worldwide:
- An additional 35,000 individuals would receive antidepressants following a spouse’s fatal MI
- An additional 11,000 would start antidepressant treatment after a spouse’s nonfatal MI
- 1,400 people would commit suicide during the 12 months after a spouse’s fatal MI
Study limitations included the reliance on medication use as a surrogate for the diagnosis of depression, and the uncertain generalizability of the findings to unmarried and non-Danish populations.
“Our study suggests that losing a spouse or having a spouse experiencing a nonfatal [acute] MI is a major public health issue for which there is very little awareness among physicians and policy makers,” they wrote.
These findings also imply that “clinical attention needs to be paid to both the patient, who is suffering from the physical and mental trauma of the event, and the spouse, who has to live through the event alongside the patient,” Fosbøl and colleagues concluded.
Primary source: European Heart Journal