Sex differences in symptoms of anxiety, depression, post-traumatic stress disorder, and cognitive function among survivors of out-of-hospital cardiac arrest

Mental Health Sequelae of Cardiac Events: A Comprehensive Review of Biological Mechanisms, Prevalence, and Interdisciplinary Care Approaches

Cardiovascular diseases are the leading cause of mortality worldwide, with postcardiac events such as myocardial infarction, acute coronary syndrome, and sudden cardiac arrest causing significant physiological trauma and psychological effects. This study explores the complex interplay between cardiac events and mental health disorders, focusing on the biological and psychological pathways that connect these conditions in at-risk populations. The acute stress response following a cardiac event involves the activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, leading to the release of stress hormones and inflammatory cytokines. Prolonged activation of these systems can result in neurotransmitter imbalances, neuroinflammation, and epigenetic modifications, increasing the susceptibility to mental health disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). Women exhibit a higher vulnerability to these conditions due to hormonal fluctuations and a more pronounced stress response. The prevalence of mental health disorders following cardiac events is substantial, with PTSD rates being particularly high among survivors of myocardial infarction and out-of-hospital cardiac arrest. These psychological conditions are associated with poor physical recovery, reduced quality of life, and an increased risk of recurrent cardiac events and mortality. Resilience and adaptive coping mechanisms serve as protective factors, highlighting the importance of integrating mental health care within cardiac rehabilitation programs. This study emphasizes the need for early detection, targeted interventions, and an interdisciplinary approach to improve mental health outcomes in patients recovering from cardiac incidents. Understanding the psychiatric sequelae of cardiac events is crucial for cardiologists, particularly in the management of postmyocardial infarction patients, ischemic attack survivors, and individuals undergoing open-heart surgery. Early detection and interdisciplinary interventions can improve long-term outcomes.

The Role of Chronic Stress in the Pathogenesis of Ischemic Heart Disease in Women

Psychological stress has emerged as a critical risk factor for cardiovascular disease, especially in women. While female participation in clinical research has improved, sex-specific data analysis and reporting often remain inadequate, limiting our ability to draw definitive conclusions for women. Conversely, preclinical studies consistently demonstrate adverse effects of stress on female health, yet the molecular mechanisms underlying this association remain elusive. Evidence suggests that female IHD pathogenesis is more complex than in males, involving multiple factors, including inflammation, contractile dysfunction, bioenergetic impairment, and remodeling. However, many of these mechanisms are primarily derived from male studies, and molecular investigations in female models are limited, hindering our understanding of the underlying biological pathways. This is particularly concerning given the increasing prevalence of ischemic heart disease in postmenopausal women. In order to fully elucidate the impact of stress on female cardiac health and develop targeted interventions, further preclinical research on female models is essential.

Associations between mental health symptoms, trauma, quality of life and coping in adults living in Ukraine: A cross-sectional study a year after the 2022 Russian invasion

We aimed to assess the mental health of adults living in Ukraine one year after onset of the Russo-Ukrainian war, along with quality of life and coping strategies. Quota sampling was used to collect online survey data from 2364 adults aged 18-79 years living in Ukraine from April 5, 2023 to May 15, 2023. Among adults living in Ukraine, 14.4 % had probable post-traumatic stress disorder (PTSD), another 8.9 % had complex PTSD (CPTSD), 44.2 % had probable depressive disorder, 23.1 % had anxiety disorder and 38.6 % showed significant loneliness. In adjusted models, the number of trauma events experienced during the war showed a dose-response association with PTSD/CPTSD and was associated with depressive disorder and anxiety disorder. Quality of life domains, particularly physical quality of life, were negatively associated with PTSD/CPTSD, depressive disorder, anxiety disorder, and number of trauma events. Maladaptive coping was positively associated with depressive disorder, anxiety disorder, PTSD/CPTSD and loneliness. All quality of life domains were positively associated with using adaptive coping strategies. Mental health disorders are highly prevalent in adults living in Ukraine one year into the war. Policy and services can promote adaptive coping strategies to improve mental health and quality of life for increased resilience during war.

Long-Term Socioeconomic and Mental Health Changes After Out-of-Hospital Cardiac Arrest in Women and Men

BACKGROUND

Long-term effects of out-of-hospital cardiac arrest (OHCA) may affect the ability to work and mental health. Our aim was to analyze 5-year changes in socioeconomic and mental health outcomes after OHCA in women and men.

METHODS

We included 259 women and 996 men from North Holland, the Netherlands, who survived 30 days after OHCA occurred between 2009 and 2015. We assessed changes in employment, income, primary earner status, and anxiety/depression (using medication proxies) from the year before the OHCA to 5 years after with generalized linear mixed models, stratified by sex. We tested differences in changes by sex with interaction terms. Additionally, we explored yearly changes. The 5-year changes after OHCA were compared with changes in a sex- and age-matched sample of people without OHCA. Differences were tested using an interaction term of time and OHCA status.

RESULTS

In both women and men (median age [Q1, Q3]: 51 [45, 55] and 54 [48, 57] years, respectively), decreases from before OHCA to 5 years thereafter were observed in the proportion employed (from 72.8% to 53.4% [women] and 80.9% to 63.7% [men]) and the median income. No change in primary earner status was observed in either sex. Dispensing of anxiety/depression medication increased only in women, especially after 1 year (odds ratio, 5.68 [95% CI, 2.05-15.74]) and 5 years (odds ratio, 5.73 [95% CI, 1.88-17.53]). Notable differences between women and men were observed for changes in primary earner status and anxiety/depression medication (eg, at year 1, odds ratio for women, 6.71 [95% CI, 1.96-23.01]; and for men, 0.69 [95% CI, 0.33-1.45]). However, except for anxiety/depression medication in women, similar changes were also observed in the general population.

CONCLUSIONS

OHCA survivors experience changes in employment, income, and primary earner status similar to the general population. However, women who survived OHCA more often received anxiety/depression medication in the years following OHCA.

Emotional distress, social support, and functional dependence predict readiness for hospital discharge in a prospective sample of cognitively intact cardiac arrest survivors

AIM

To inform screening, referral and treatment initiatives, we tested the hypothesis that emotional distress, social support, functional dependence, and cognitive impairment within 72 hours prior to discharge predict readiness for discharge in awake and alert cardiac arrest (CA) survivors.

METHODS

This was a secondary analysis of a prospective single-center cohort of CA survivors enrolled between 4/2021 and 9/2022. We quantified emotional distress using the Posttraumatic Stress Disorder Checklist-5 and PROMIS Emotional Distress - Anxiety and Depression Short Forms 4a; perceived social support using the ENRICHD Social Support Inventory; functional dependence using the modified Rankin Scale; and cognitive impairment using the Telephone Interview for Cognitive Status. Our primary outcome was readiness for discharge, measured using the Readiness for Hospital Discharge Scale. We used multivariable linear regression to test the independent association of each survivorship factor and readiness for discharge.

RESULTS

We included 110 patients (64% male, 88% white, mean age 59 [standard deviation ± 13.1 years]). Emotional distress, functional dependence, and social support were independently associated with readiness for discharge (adjusted β's [absolute value]: 0.25-0.30, all p < 0.05).

CONCLUSIONS

Hospital systems should consider implementing routine in-hospital screening for emotional distress, social support, and functional dependence for CA survivors who are awake, alert and approaching hospital discharge, and prioritize brief in hospital treatment or post-discharge referrals.