Social Support as a Protective Shield Against Daily Triggers: The Impact of Relationship Quality and Quantity on the Happiness of Open-Heart Surgery Patients with Childhood Trauma
DOI:
https://doi.org/10.61838/kman.jndd.3.4.13Keywords:
Adverse Childhood Experiences, Social Support, Relationship Quality, Happiness, Daily Triggers, Open, Heart SurgeryAbstract
Purpose: The present study aimed to examine the moderating role of relationship quality and quantity in mitigating the negative effects of daily triggers on the happiness of cardiac patients with adverse childhood experiences.
Methodology: This descriptive-correlational study was conducted using a multivariate hierarchical linear modeling approach. The statistical population comprised patients undergoing open-heart surgery at Shahid Rajaei Heart Hospital in 2022, selected through convenience sampling. Data were collected using the Adverse Childhood Experiences Questionnaire (ACE-IQ) and daily assessments, including happiness, trigger intensity, and measurements of relationship quality and quantity.
Findings: The results indicated that daily triggers had a significant negative effect on patients' happiness. Relationship quality acted as a strong buffering factor, reducing the negative impact of daily triggers. Additionally, the quantity of relationships (duration of social interactions) played a moderating role in maintaining the patients' happiness.
Conclusion: The findings highlight the importance of social support in maintaining the mental health of cardiac patients. High-quality social relationships create a psychological shield that prevents a decline in happiness when facing daily triggers. Clinical interventions focused on enhancing social interactions and psychological support may contribute to improving the quality of life for these patients.
Downloads
References
Abdel-Khalek, A. M. (2006). Measuring happiness with a single-item scale. Social Behavior and Personality: an international journal, 34(2), 139-150. https://doi.org/10.2224/sbp.2006.34.2.139
Arab, Mohammad, Movahedkar, & Hosseini. (2015). Investigating the role of childhood violence experience in mental health of individuals 18 years and older in Tehran. Hakim Research Journal, 18(1), 55-67. https://hakim.tums.ac.ir/article-1-1486-fa.html
Baher Talari, M., Mikaeili, N., Aghajani, S., & Habibi, N. (2024). Prediction of Marital Disaffection Based on Cognitive Distortion, Interpersonal Forgiveness and Emotion Regulation Strategies in Married People. Social Psychology Research, 14(53), 1-16. https://www.socialpsychology.ir/article_198039.html?lang=en
Banai, E., Mikulincer, M., & Shaver, P. R. (2005). "Selfobject" Needs in Kohut's Self Psychology: Links With Attachment, Self-Cohesion, Affect Regulation, and Adjustment. Psychoanalytic Psychology, 22(2), 224. https://doi.org/10.1037/0736-9735.22.2.224
Bellis, M. A., Hughes, K., Jones, A., Perkins, C., & McHale, P. (2013). Childhood happiness and violence: a retrospective study of their impacts on adult well-being. BMJ open, 3(9), e003427. https://doi.org/10.1136/bmjopen-2013-003427
Berscheid, E., & Reis, H. (1998). Close relationships and attraction. The handbook of social psychology, 2, 193-281. https://ubt.opus.hbz-nrw.de/files/72/20010724.pdf
Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary methods: Capturing life as it is lived. Annual review of psychology, 54(1), 579-616. https://doi.org/10.1146/annurev.psych.54.101601.145030
Bowlby, J. (1988). A secure base. Basic. https://ubt.opus.hbz-nrw.de/files/72/20010724.pdf
Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasis on underlying mechanisms. Perspectives in biology and medicine, 46(3), S39-S52. https://doi.org/10.1353/pbm.2003.0052
Changi Ashtiani, M., Fattahi, N., Balali, D., Alavi, S. H., & Mahmoudzadeh, M. (2024). Effectiveness of Mindfulness-Based Schema Therapy on Mental Pain and Experiential Avoidance in Patients with Cardiovascular Diseases. Journal of Assessment and Research in Applied Counseling (JARAC), 6(1), 90-96. https://doi.org/10.61838/kman.jarac.6.1.10
Diener, E. (2000). Subjective well-being: The science of happiness and a proposal for a national index. American psychologist, 55(1), 34. https://doi.org/10.1037/0003-066X.55.1.34
Diener, E. (2021). Subjective well-being in cross-cultural perspective. Key issues in cross-cultural psychology, 319-330. https://www.scirp.org/reference/referencespapers?referenceid=1539532
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345. https://doi.org/10.1016/S0005-7967(99)00123-0
Eysenck, M. W. (2024). Happiness: Facts and myths. Taylor & Francis. https://doi.org/10.4324/9781003471394
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., & Edwards, V. (2019). Reprint of: relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 56(6), 774-786. https://doi.org/10.1016/j.amepre.2019.04.001
Flores-Torres, M. H., Comerford, E., Signorello, L., Grodstein, F., Lopez-Ridaura, R., & de Castro, F. (2020). Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women. Child abuse & neglect, 99, 104175. https://doi.org/10.1016/j.chiabu.2020.104175
Folkman, S. (2009). Commentary on the special section "theory-based approaches to stress and coping" questions, answers, issues, and next steps in stress and coping research. European Psychologist, 14(1), 72-77. https://doi.org/10.1027/1016-9040.14.1.72
Fu, Y. c. (2005). Measuring personal networks with daily contacts: a single-item survey question and the contact diary. Social Networks, 27(3), 169-186. https://doi.org/10.1016/j.socnet.2005.01.005
Gharavi, M. (2011). Investigating the relationship between adult attachment style to parents with stress, anxiety and depression. Journal of Fundamentals of Mental Health, 13(50), 194-202. https://jfmh.mums.ac.ir/article_1019.html
Greger, H. K., Myhre, A. K., Klöckner, C. A., & Jozefiak, T. (2017). Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use. Child abuse & neglect, 70, 122-133. https://doi.org/10.1016/j.chiabu.2017.06.013
He, Z.-Q., Wang, Q., Xu, C.-Y., Yang, J., & Huang, Y.-J. (2024). Depression and anxiety symptom network structure among patients with coronary heart disease and association with quality of life: protocol for a multicentre cross-sectional and prospective longitudinal study. BMJ open, 14(2), e079298. https://doi.org/10.1136/bmjopen-2023-079298
He, Z. Q., Wang, Q., Xu, C. Y., Yang, J., & Huang, Y. J. (2024). Protocol: Depression and anxiety symptom network structure among patients with coronary heart disease and association with quality of life: protocol for a multicentre cross-sectional and prospective longitudinal study. BMJ open, 14(2). https://doi.org/10.1136/bmjopen-2023-079298
Hembree, E. A., & Foa, E. B. (2010). Cognitive behavioral treatments for PTSD. Clinician's guide to posttraumatic stress disorder, 177-203. https://psycnet.apa.org/record/2010-21260-008
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLOS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316
Hughes, K., Lowey, H., Quigg, Z., & Bellis, M. A. (2016). Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey. BMC public health, 16, 1-11. https://doi.org/10.1186/s12889-016-2906-3
Jaswal, N., Sharma, D., Bhardwaj, B., & Kraus, S. (2024). Promoting well-being through happiness at work: a systematic literature review and future research agenda. Management Decision, 62(13), 332-369. https://doi.org/10.1108/MD-08-2023-1492
Kalmijn, W., & Veenhoven, R. (2005). Measuring inequality of happiness in nations: In search for proper statistics. Journal of Happiness Studies, 6, 357-396. https://doi.org/10.1007/s10902-005-8855-7
Kermanian, Golshani, Baghdasarians, Anita, & Jamhari. (2023). Developing a structural model of narcissism based on early life traumas, family function and perceived maternal parenting styles with the mediation of emotion regulation difficulty and perfectionism. Social Psychology Research, 13(50), 93-109. https://www.socialpsychology.ir/article_178113.html
Khodabandeh, F., Khalilzadeh, M., & Hemati, Z. (2018). The impact of adverse childhood experiences on adulthood aggression and self-esteem-a study on male forensic clients. Novelty in Biomedicine, 6(2), 85-91. https://journals.sbmu.ac.ir/nbm/article/view/20695
Kohut, H. (1971). The analysis of the self. International Universities Press. https://www.scirp.org/reference/ReferencesPapers?ReferenceID=1464977
Madigan, S., Wade, M., Plamondon, A., Maguire, J. L., & Jenkins, J. M. (2017). Maternal adverse childhood experience and infant health: Biomedical and psychosocial risks as intermediary mechanisms. The Journal of Pediatrics, 187, 282-289. https://doi.org/10.1016/j.jpeds.2017.04.052
Mair, C., Cunradi, C. B., & Todd, M. (2012). Adverse childhood experiences and intimate partner violence: Testing psychosocial mediational pathways among couples. Annals of Epidemiology, 22(12), 832-839. https://doi.org/10.1016/j.annepidem.2012.09.003
Mehl, M. C., & Tamlin. (2012). Handbook of Research Methods for Studying Daily Life. https://www.researchgate.net/publication/257947348_Handbook_of_Research_Methods_for_Studying_Daily_Life
Pieh, C., O´ Rourke, T., Budimir, S., & Probst, T. (2020). Relationship quality and mental health during COVID-19 lockdown. PLoS One, 15(9), e0238906. https://doi.org/10.1371/journal.pone.0238906
Poole, J. C., Dobson, K. S., & Pusch, D. (2018). Do adverse childhood experiences predict adult interpersonal difficulties? The role of emotion dysregulation. Child abuse & neglect, 80, 123-133. https://doi.org/10.1016/j.chiabu.2018.03.006
Rubino, F., Pompei, G., Brugaletta, S., Collet, C., & Kunadian, V. (2024). The role of physiology in the contemporary management of coronary artery disease. Heart, 110(6), 391-398. https://doi.org/10.1136/heartjnl-2023-322641
Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61, 101860. https://doi.org/10.1016/j.cedpsych.2020.101860
Sandvik, E., Diener, E., & Seidlitz, L. (1993). Subjective well‐being: The convergence and stability of self‐report and non‐self‐report measures. Journal of personality, 61(3), 317-342. https://doi.org/10.1111/j.1467-6494.1993.tb00283.x
Shah, S. B., Barsky, A. J., Vaillant, G., & Waldinger, R. J. (2014). Childhood environment as a predictor of perceived health status in late life. Health Psychology Research, 2(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC4768550/
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books. https://ia601604.us.archive.org/35/items/the-body-keeps-the-score-pdf/The-Body-Keeps-the-Score-PDF.pdf
Waldinger, R. J., & Schulz, M. S. (2010). What's love got to do with it? Social functioning, perceived health, and daily happiness in married octogenarians. Psychology and Aging, 25(2), 422. https://doi.org/10.1037/a0019087
Whitton, S. W., Waldinger, R. J., Schulz, M. S., Allen, J. P., Crowell, J. A., & Hauser, S. T. (2008). Prospective associations from family-of-origin interactions to adult marital interactions and relationship adjustment. Journal of Family Psychology, 22(2), 274. https://doi.org/10.1037/0893-3200.22.2.274
Yang, Y. (2008). Social inequalities in happiness in the United States, 1972 to 2004: An age-period-cohort analysis. American Sociological Review, 73(2), 204-226. https://doi.org/10.1177/000312240807300203
Zimmerman, M. A., & Arunkumar, R. (1994). Resiliency research: Implications for schools and policy. Social policy report, 8(4), 1-20. https://srcd.onlinelibrary.wiley.com/doi/10.1002/j.2379-3988.1994.tb00032.x
Downloads
Publication Timeline
- Submitted
- Revised
- Accepted
Issue
Section
License
Copyright (c) 2025 Saeid Dabagh Ghazvini (Author); Bahador Baharestani (Corresponding author); Mahdieh Moinalghorabaei, Tahereh Ranjbaripour, Alireza Alizadeh Ghavidel (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.