Perceived Stress After Acute Myocardial Infarction: A Comparison Between Young and Middle-Aged Women Versus Men

Abstract

Objective To examine how psychological stress changes over time in young and middle-aged patients after experiencing an acute myocardial infarction (AMI) and whether these changes over time differ between men and women. Methods We analyzed data obtained from 2,358 women and 1,151 men aged 18–55 years hospitalized for an AMI. Psychological stress was measured using the 14-item Perceived Stress Scale (PSS-14) at initial hospitalization and at 1 and 12 months after AMI. We used linear mixed effects models to examine changes in PSS-14 scores over time and sex differences in these changes, while adjusting for patient characteristics and accounting for correlation among repeated observations within patients. Results Overall, patients’ perceived stress decreased over time, especially during the first month after AMI. Women had higher levels of perceived stress than men throughout the 12-month period (difference in PSS-14 score = 3.63, 95% confidence interval [CI] = 3.08 to 4.18, p<.001), but they did not differ in how stress changed over time. Adjustment for patient characteristics did not alter the overall pattern of sex difference in changes of perceived stress over time other than attenuating the magnitude of sex difference in PSS-14 score (difference between women and men = 1.74, 95% CI: 1.32 to 2.16, p<.001). The magnitude of sex differences in perceived stress was similar in patients with versus without post-AMI angina, even though patients with angina experienced less improvement in PSS-14 score than those without angina. Conclusions In young and middle-aged patients with AMI, women reported higher levels of perceived stress than men throughout the first 12 months of recovery. However, women and men had a similar pattern in how perceived stress changed over time.

Young Women With Acute Myocardial Infarction

“…58 In addition to having poorer functioning young women are less likely to return to work over a period of 12-months, 59 and experience a higher risk of depression and stress in the year following AMI. 43, 60, 61 …”

Acute myocardial infarction in young women: current perspectives

“…Young women also have greater prevalence of depression, anxiety, and stress, with higher depression and stress scores at the time of AMI presentation compared with men, as a function of greater comorbidities, familial conflict, financial concerns, and caregiving demands. 8 , 17 , 26 , 27 Certainly, untreated depression in AMI patients is correlated with greater risk of 1-year mortality than patients with treated depression or patients without history of depression. 28 In the GENESIS-PRAXY study, young women had greater traditional risk factors than young men, but also greater non-traditional risk factors such as anxiety, low household income, and depression ( Figure 2 ).…”

What Do We Know About Young Adult Cardiac Patients' Experience? A Systematic Review

“…Ischemia due to stress was three times higher among young women than among men (Vaccarino et al, 2014 , 2016 ). Furthermore, perceived stress scores were higher among coronary women compared to the scores of coronary men both during their hospitalization and over a 2-years period (Brummett et al, 2004 ; Lindau et al, 2014 , 2016 ; Xu et al, 2015 , 2017 ). However, these data are to be taken lightly as the number of YAC patients in these studies was either small or undisclosed.…”

“…Depression rates were inconsistent across studies, ranging from 3 to 90% depending on the sample and the measures used (Lavie and Milani, 2006 ; Schweikert et al, 2009 ; Hinz et al, 2011 ; Deasy et al, 2012 ; Joubert et al, 2013 ; Bucholz et al, 2014 ; Leung Yinko et al, 2014 , 2015 ; Lindau et al, 2014 , 2016 ; Shah et al, 2014 ; Vaccarino et al, 2014 , 2016 ; Dreyer et al, 2015 , 2016 ; Xu et al, 2015 , 2017 ; Koutrolou-Sotiropoulou et al, 2016 ; Pelletier et al, 2016a ). In the VIRGO studies, which had the most important samples and the highest quality methodology despite the use of different tools, depression rates ranged from 21 to 48%.…”

“…After significant stress during hospitalization for a cardiac event, stress decreased over time, both 1 month later and 2 years later (Brummett et al, 2004 ; Beckman et al, 2016 ; Xu et al, 2017 ). Ischemia due to stress was three times higher among young women than among men (Vaccarino et al, 2014 , 2016 ).…”