Analysis of Posttraumatic Stress Disorder, Depression, Anxiety, and Resiliency Within the Unique Population of Spontaneous Coronary Artery Dissection Survivors

Alexis K Johnson, Sharonne N Hayes, Craig Sawchuk, Matthew P Johnson, Patricia J Best, Rajiv Gulati, Marysia S Tweet, Alexis K Johnson, Sharonne N Hayes, Craig Sawchuk, Matthew P Johnson, Patricia J Best, Rajiv Gulati, Marysia S Tweet

Abstract

Background Mental health after spontaneous coronary artery dissection (SCAD), a cause of myocardial infarction in young women, remains largely unexplored. We assessed the prevalence and severity of psychiatric symptoms after SCAD. Methods and Results Individuals with confirmed SCAD who consented to the Mayo Clinic "Virtual" Multicenter SCAD Registry were sent the Posttraumatic Stress Disorder Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Anxiety Sensitivity Index, Connor-Davidson Resilience Scale, 36-Item Short-Form Health Survey, and an SCAD-specific questionnaire. Among 782 patients contacted, 512 surveys were returned. Most respondents were women (97.5%), with median age at time of SCAD and survey completion of 47 and 52 years, respectively. Eighty-two percent had at least one trauma, with mild or more posttraumatic stress disorder symptoms in 28%. Symptoms of anxiety and depression were observed in 41% and 32%, respectively. On multivariable analysis, those of younger age at first SCAD and low resiliency scored higher on measures of trauma, anxiety, and depression. Those with higher anxiety sensitivity had more severe anxiety and posttraumatic stress disorder symptoms. Emotional and social quality of life was higher in those with high resiliency scores. Time from SCAD event to survey completion was associated with lower Generalized Anxiety Disorder-7 score severity. Conclusions Survivors of SCAD have significant rates of posttraumatic stress disorder, depression, and anxiety, which are associated with lower quality of life specifically among those with lower resiliency. Given the prevalence and potential impact, screening and treatment for the psychological distress is advised. Behavioral interventions targeted toward resiliency training may be beneficial for this patient population.

Keywords: acute coronary syndromes; anxiety; depression; myocardial infarction; posttraumatic stress disorder; spontaneous coronary artery dissection; women.

Figures

Figure 1
Figure 1
The distribution of all traumatic events experienced by individuals who completed the screening portion of the Posttraumatic Stress Disorder Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (n=714).
Figure 2
Figure 2
Posttraumatic stress disorder (PTSD) symptom severity distribution based on PTSD Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PDS‐5) survey responses (n=408). Severity is defined by the survey scoring system, with 59 being very severe.
Figure 3
Figure 3
Anxiety symptom severity based on the Generalized Anxiety Disorder‐7 (GAD‐7) responses, with <5 being minimal, 5 to 9 being mild, 10 to 14 being moderate, and >14 being severe (n=435).
Figure 4
Figure 4
Depression symptom severity based on Patient Health Questionnaire‐9 (PHQ‐9) responses, with <5 being minimal, 5 to 9 being mild, 10 to 14 being moderate, 15 to 19 being moderately severe, and >19 being severe (n=447).

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