Women are more likely to develop anxiety and depression after a myocardial infarction (MI), or heart attack, than men, according to research from Lithuania.

“The World Health Organization predicts that by 2020 depression will be the second leading cause of disability and mortality in the world, surpassed only by ischaemic heart disease. Major depression follows MI in approximately 18% of cases and is an important predictor of disability and poor quality of life in the year post-MI,” said Professor Pranas Serpytis, who presented the results at the 2014 Acute Cardiovascular Care Congress in Geneva.

The study looked at the impact of cardiovascular disease risk factors and gender on the risk of developing depression and anxiety after a heart attack.

“Patients with depression are nearly 6 times more likely to die within 6 months after an MI than those without depression,” added Serpytis. “The increased risk of death in patients with depression persists up to 18 months after the MI. But despite the fact that post-MI depression is common and burdensome, the condition remains under-recognised and undertreated.”

Depression and Anxiety

The study involved 160 patients with myocardial infarction admitted to the Vilnius University Hospital Santariskiu Clinics in Vilnius, Lithuania.

Participants were interviewed at least 1 month following the heart attack to gather information on demographics, such as sex, age, education, marital status, and clinical characteristics including incidence of diabetes mellitus, previous treatment for hypertension, previous MI, as well as other cardiovascular disease risk factors like smoking, low physical activity, and history of mental health issues.

Depression and anxiety were assessed using HADS, the Hospital Anxiety and Depression Scale. The scale is no depression and anxiety equals 0-7 score, possible depression and anxiety 8-10 score, mild to moderate levels of depression and anxiety symptoms receive 11+ score.

“We found that women were more likely to develop anxiety and depression after a heart attack than men. More research is needed to discover the possible reasons for this,” Professor Serpytis said.

Anxiety and Smoking

The study also found a relationship between anxiety and smoking.

15.6% of the patients were current smokers and their mean HADS score for anxiety was 10.16 (±4.9). An additional 77.5% of patients had never smoked and their mean HADS score for anxiety was 7.3 (±4.1), while the 6.9% patients who had quit smoking more than 2 years ago had a mean HADS score for anxiety of 4.55 (±3.7) (p<0.05).

“Current smokers were more likely to have anxiety after an MI than never smokers or people who had quit smoking more than two years ago. We did not find any association between smoking and depression after an MI,” said Professor Serpytis.

Physically inactive patients were prone to being depressed, as well. 64% of patients with depression said they were not physically active (p<0.05).

Professor Serpytis said: “Women are misrepresented in many clinical studies on MI even though they often have worse outcomes. Our study shows that women are more likely to develop anxiety and depression after MI than men but until now this issue has been largely unnoticed. Clinicians should assess MI patients, particularly women, for anxiety and depression so that timely treatment can be started.”

“Our study suggests that encouraging patients to quit smoking and increase their physical activity levels should reduce their risks of anxiety and depression after MI. More research is needed on the links between myocardial infarction and mental health problems."

More Information:

P Serpytis, A Andriuskiene, S Pelanyte, V Matelyte, R Palsauskaite, R Serpytis Factors for 30 days survival in patients with acute myocardial infarction European Heart Journal: Acute Cardiovascular Care Abstract Supplement ( 2014 ) 3 ( S2 ), 94

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