Sex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients with Acute Myocardial Infarction
Background—Younger age and female sex are both associated with greater mental stress in the general population, but limited data exist on status of perceived stress in young and middle-aged patients presenting with acute myocardial infarction (AMI).
Methods and Results—We examined sex difference in stress, contributing factors to such difference, and whether this difference helps explain sex-based disparities in 1-month recovery using data from 3,572 AMI patients (2,397 women and 1,175 men) 18-55 years of age. The average score of 14-item Perceived Stress Scale (PSS-14) at baseline was 23.4 for men and 27.0 for women (p<0.001). Higher stress in women was largely explained by sex differences in comorbidities, physical and mental health status, intra-family conflict, care-giving demand, and financial hardship. After adjustment for demographic and clinical characteristics, women had worse recovery than men at 1-month post-AMI, with mean differences in improvement score ranging from -0.04 for Euro-Qol utility index to -3.96 for angina-related quality of life (p<0.05 for all). Further adjustment for baseline stress reduced these sex-based differences in recovery to -0.03 to -3.63, which however remained statistically significant (p<0.05 for all). High stress at baseline was associated with significantly worse recovery in angina-specific and overall quality of life, as well as mental health status. The effect of baseline stress on recovery did not vary between men and women.
Conclusions—Among young and middle-aged patients, higher stress at baseline is associated with worse recovery in multiple health outcomes after AMI. Women perceive greater psychological stress than men at baseline, which partially explains women's worse recovery.
- Received August 19, 2014.
- Revision received October 19, 2014.
- Accepted December 8, 2014.