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Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study

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Abstract

Purpose

Our study examined psychosocial risk and protective features affecting cardiovascular and mortality disparities in American Indians, including stress, anger, cynicism, trauma, depression, quality of life, and social support.

Methods

The Strong Heart Family Study cohort recruited American Indian adults from 12 communities over 3 regions in 2001–2003 (N = 2786). Psychosocial measures included Cohen Perceived Stress, Spielberger Anger Expression, Cook-Medley cynicism subscale, symptoms of post-traumatic stress disorder, Centers for Epidemiologic Studies Depression scale, Short Form 12-a quality of life scale, and the Social Support and Social Undermining scale. Cardiovascular events and all-cause mortality were evaluated by surveillance and physician adjudication through 2017.

Results

Participants were middle-aged, 40% male, with mean 12 years formal education. Depression symptoms were correlated with anger, cynicism, poor quality of life, isolation, criticism; better social support was correlated with lower cynicism, anger, and trauma. Adjusted time-to-event regressions found that depression, (poor) quality of life, and social isolation scores formed higher risk for mortality and cardiovascular events, and social support was associated with lower risk. Social support partially explained risk associations in causal mediation analyses.

Conclusion

Altogether, our findings suggest that social support is associated with better mood and quality of life; and lower cynicism, stress, and disease risk—even when said risk may be increased by comorbidities. Future research should examine whether enhancing social support can prospectively reduce risk, as an efficient, cost-effective intervention opportunity that may be enacted at the community level.

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Data availability

The data used in these analyses are part of a data repository for the Strong Heart Study cohort. These data are the intellectual property of the tribes from which the data were collected, and their use for analysis is contingent on formal approval procedures. For more information, please visit strongheartstudy.org.

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Acknowledgements

The authors wish to thank Strong Heart Study staff and participants. The opinions included herein are those of the authors, and not necessarily those of the Indian Health Service (IHS). This work has been funded in whole or in part with federal funds from the National Institutes of Health by research grants K01AG057821, P50AG005136, R01HL109315, R01HL109284, and R01HL109319; and by the Health Equity Research Center, a Washington State University strategic research initiative.

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Authors and Affiliations

  1. Washington State University Elson S Floyd College of Medicine, 1100 Olive Way Suite 1200, Seattle, WA, 98101, USA

    Astrid Suchy-Dicey, Harry Eyituoyo & Dedra Buchwald

  2. Missouri Breaks Industries Research, Inc., Eagle Butte, USA

    Marcia O’Leary

  3. Texas Biomedical Research Institute, San Antonio, TX, USA

    Shelley A. Cole

  4. Department of Health, Oklahoma State, Stillwater, USA

    Aminata Traore

  5. Department of Psychology, University of New Mexico, Albuquerque, USA

    Steve Verney

  6. MedStar Health Research Institute, Hyattsville, USA

    Barbara Howard

  7. University of Colorado, Denver, USA

    Spero Manson

  8. Department of Psychology, Washington State University, Pullman, USA

    Paul Whitney

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  1. Astrid Suchy-Dicey
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Correspondence to Astrid Suchy-Dicey.

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Suchy-Dicey, A., Eyituoyo, H., O’Leary, M. et al. Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study. Soc Psychiatry Psychiatr Epidemiol 57, 1421–1433 (2022). https://doi.org/10.1007/s00127-022-02237-7

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