Prevalence and predictors of depression and anxiety among survivors of myocardial infarction due to spontaneous coronary artery dissection

J Cardiopulm Rehabil Prev. 2014 Mar-Apr;34(2):138-42. doi: 10.1097/HCR.0000000000000030.


Purpose: Depression and anxiety after myocardial infarction (MI) are common and associated with increased morbidity and mortality. The epidemiology and pathophysiology of MI due to spontaneous coronary artery dissection (SCAD) differs substantially from atherosclerotic MI, and rates of mental health comorbidities after SCAD are unknown. We aimed to determine the prevalence and predictors of depression/anxiety in SCAD survivors.

Methods: In this cross-sectional study, 158 SCAD survivors (97% women; mean age, 45.5 ± 9.3 years) were screened for depression/anxiety via surveys, including the Patient Health Questionnaire Depression Scale (PHQ-9) and Generalized Anxiety Disorder 7-Item Scale (GAD-7), a mean 3.7 ± 4.7 years after SCAD. Comorbidities and environmental, socioeconomic, and clinical cardiovascular characteristics were obtained from the surveys.

Results: Since their initial SCAD MI, 51 (33%) patients had received treatment with medications or counseling for depression and 57 (37%) for anxiety. When surveyed, 46 (31.7%) were taking antidepressant or anxiolytic medications. Overall, mean PHQ-9 (4.1) and GAD-7 (4.7) scores suggested borderline mild depression/anxiety (normal range: 0-4). Younger age was associated with higher PHQ-9 (P = .04) and GAD-7 (P = .02) scores. The 19 (12%) patients with peripartum SCAD had higher mean PHQ-9 (6.7 vs 3.7; P < .0005) and GAD-7 (8.1 vs 4.3; P = .003) scores. Patients treated with percutaneous coronary intervention had lower PHQ-9 (1.5; P = .02) and GAD-7 (2.4; P = .004) scores.

Conclusions: Symptoms of depression/anxiety are common in patients with MI due to SCAD, particularly younger women and those with peripartum SCAD. The PHQ-9 and GAD-7 assessments may detect depression/anxiety in SCAD survivors who do not self-report these disorders, suggesting a role for routine screening in these patients.

MeSH terms

  • Adult
  • Age Factors
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Anxiety / diagnosis*
  • Anxiety / drug therapy
  • Anxiety / epidemiology
  • Coronary Vessels / injuries*
  • Cross-Sectional Studies
  • Depression / diagnosis*
  • Depression / drug therapy
  • Depression / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology
  • Myocardial Infarction / psychology*
  • Percutaneous Coronary Intervention
  • Peripartum Period
  • Pregnancy
  • Prevalence
  • Severity of Illness Index
  • Stress, Psychological / epidemiology
  • Surveys and Questionnaires
  • Survivors / psychology*


  • Anti-Anxiety Agents
  • Antidepressive Agents