Stress before the event, care after: Psychosocial stressors, psychiatric care, and cardiac rehabilitation after early-onset myocardial infarction

BACKGROUND Early-onset myocardial infarction (MI) has substantial consequences and sex-specific risk profiles. Psychosocial stressors and mental health may influence MI recovery. OBJECTIVES To examine sex differences in pre-MI psychosocial stressors, post-discharge mental health pathways, cardiac rehabilitation (CR), and 12-month secondary prevention. METHODS In this observational two-centre cohort (2021-2024), consecutive adults aged ≤45 years with confirmed MI and coronary angiography completed psychosocial questionnaires during hospitalisation; first-ever MI was not required. Telephone follow-up at 12 ± 3 months assessed mental health care, CR, LDL cholesterol, smoking, exercise, and psychiatric diagnoses. RESULTS Among 301 patients (214 men, 87 women; median age 43 years), 16 (5.3%) had prior MI. Women more often had MINOCA or SCAD and reported acute emotional stress before MI (58.6%vs 11.7%), serious family illness (18.4%vs 3.7%), and a child with special health care needs (20.7%vs 4.2%). Women had higher GAD-2 and PHQ-2 scores. Most patients reported no physician-initiated mental health discussion (78.4%), particularly men (82.9%vs 67.1%); women more often sought help (36.5%vs 16.1%). CR referral/attendance did not differ by sex. At follow-up, LDL decreased from 3.6 to 1.7 mmol/L and smoking from 78.5% to 46.8%. CONCLUSION Psychosocial stressors and psychological symptoms differed by sex, while clinician-initiated mental health discussions were uncommon. Findings are associative and hypothesis-generating, supporting psychosocial screening and referral pathways in cardiology follow-up and CR.