Effectiveness of psychological interventions in reducing post-traumatic stress among post-myocardial infarction patients: a systematic review and meta-analysis

Abstract

Aims: Myocardial infarction (MI) can lead to post-traumatic stress disorder (PTSD) which frequently occurs with anxiety and depression, impairing daily functioning and increasing the risk of recurrent cardiovascular events. While psychological interventions have shown promise in reducing anxiety and depression, their effectiveness for PTSD in post-MI patients remains unexplored. This systematic review and meta-analysis aim to evaluate the effectiveness of psychological interventions on PTSD, anxiety, and depression in post-MI patients.

Methods and results: A comprehensive search of databases (Cochrane, CINAHL, PubMed, PsycINFO, Scopus, Embase, Web of Science, CNKI, Wanfang, CBM, ProQuest Dissertations and Theses Global, ClinicalTrials.gov) was conducted until June 2024, identifying randomized controlled trials and quasi-experimental studies assessing psychological interventions in post-MI patients. Study quality was evaluated using the Cochrane Risk of Bias and ROBINS-I tools. Post-traumatic stress disorder outcomes were pooled using meta-analysis in RevMan 5.4. Narrative synthesis was conducted where meta-analysis was not feasible. Nine studies involving 1065 participants were included. Psychological interventions significantly reduced PTSD symptoms {standardized mean difference (SMD) = -0.43 [95% confidence interval (CI): -0.70 to -0.16, P = 0.002]}, anxiety, and depression post-intervention. Subgroup analyses found that intervention components influenced effectiveness, with first-line treatments [eye movement desensitization and reprocessing (EMDR) and cognitive-behavioural therapy (CBT)] demonstrating a medium effect (SMD = -0.40; 95% CI: -0.74 to -0.07; P = 0.02). No significant subgroup differences were found based on the control condition or geographical location of studies.

Conclusion: Psychological interventions, particularly CBT and EMDR, were effective in alleviating PTSD, anxiety, and depression in post-MI patients. Future high-quality research is needed to identify active components and optimize these psychological interventions.

Registration: Prospero CRD42024528138.

Keywords: Cognitive-behavioural therapy; Eye movement desensitization reprocessing; Myocardial infarction; Post-traumatic stress disorder; Psychological intervention; Systematic review.