FEMALE RISK FACTORS FOR POST-INFARCTION DEPRESSION AND ANXIETY: THE FRIDA STUDY

Abstract

Cardiovascular disease (CVD) is the leading global cause of mortality, with ischemic heart disease causing the majority of CV deaths. CVD is traditionally considered to be most prominent in males. Yet, female patients demonstrate a higher mortality rate than males within a year of acute coronary syndrome (ACS) and at the five-year mark. Several studies demonstrate that female patients are significantly more likely to experience depression and anxiety following ACS, correlated with higher rates of CV morbidity, mortality, and rehospitalization. Revised guidelines to address mental health following ACS may be developed with support from studies identifying the CV risk factors and psychosocial determinants of health that elevate risk in female patients. We aimed to identify the CV risk factors, demographic, and socioeconomic variables correlated with increased Hospital Anxiety and Depression Scale (HADS) scores (HADS-Depression ≥8; HADS-Anxiety ≥8) at the time of an acute coronary event (within 72 hours of ACS). We further set out to determine whether increased depression and anxiety scores at baseline correlate with three and six-month outcomes (repeated HADS questionnaire, Cardiac Anxiety Questionnaire, major adverse cardiac events (MACE), Short Form-12 Health Survey, and Somatic Symptom Scale-8). This prospective multi-center questionnaire-based clinical research study features data collected at baseline and at three and six months plus statistically computed descriptive and inferential values (Fisher Exact test for binary variables, T-test for continuous variable (age), linear odds ratios, logistic regression) used to observe distributions and significance between groups. We identify a key group of variables associated with HADS-A≥8 (low income, previous history of mental illness, and low social support) as well as HADS-D≥8 (gender, unemployment, low income, unstable housing, previous history of mental illness, stress, and low social support). Our results can inform tailored interventions following ACS in primary care and cardiac rehabilitation while understanding identified risk factor correlations can better inform prevention strategies at the public health level.