Red flags for depression and PTSD following acute myocardial infarction: the role of early psychological symptoms

Patients who have experienced an acute myocardial infarction (AMI) are at increased risk of developing depression or post-traumatic stress disorder (PTSD) in the long term. However, whether these psychiatric comorbidities are preceded by early psychological symptoms appearing within the first days after AMI remains unclear. This study provides the identification of early psychological symptoms after AMI and evaluates their predictive value for the subsequent development of AMI-related depression and PTSD. A cohort of 129 AMI patients underwent assessments for early psychological symptoms (depressive symptoms, anxiety, intrusions, avoidance, and hyperarousal) within the first days after AMI using the psychometric questionnaires HAMD-17, HADS, and IES-R. Patients with clinically significant depression or PTSD within the year prior to AMI were excluded based on a clinical assessment and a review of medical records conducted by an experienced consultation-liaison psychiatrist. At a six-month follow-up, long-term depression and PTSD were diagnosed based on the HAMD-17 and CAPS-5, with PTSD assessments explicitly keyed to AMI. Stepwise multiple regression analyses identified early psychological predictors of depression and PTSD following AMI. Five days after AMI, 55 (43%) out of 129 participants exhibited early depressive symptoms, which were strongly associated with hyperarousal, intrusions, avoidance, and anxiety symptoms. Women, individuals living alone, and those with a history of psychiatric illness or treatment were at increased risk of developing these early psychological symptoms. In 80% of these patients, early depressive symptoms progressed in the long term to clinically significant depression, with 49% also developing comorbid PTSD. PTSD without clinically significant depression occurred only in subclinical form. Predictors for AMI-induced depression in the long term included early depressive symptoms, hyperarousal, and living in a solitary arrangement. Predictors for comorbid PTSD included early avoidance symptoms and solitary living arrangements. In this study, women, individuals living alone, and those with a history of psychiatric illness were particularly affected by early psychological symptoms such as depressive symptoms, hyperarousal and avoidance behaviour within the first days after an AMI. These early psychological symptoms emerging within the first days after AMI and solitary living arrangements predict the development of AMI-related depression and PTSD in the long term. These findings suggest that a comprehensive biopsychosocial post-AMI treatment should incorporate an early psychological screening within the first days after AMI to identify high-risk patients at an early stage and to prevent AMI-related depression and PTSD in the long term. The observed impact of gender, living in a solitary arrangement and a history of psychiatric morbidity highlights the need for personalized care plans that also address preexisting mental health conditions and incorporate gender-specific psychosocial interventions. High-risk patients identified in this context may benefit from early admission to community-based psychosocial services.