ABC | Volume 111, Nº5, November 2018

Original Article Serpytis et al Anxiety and depression after myocardial infarction Arq Bras Cardiol. 2018; 111(5):676-683 Table 3 – Cardiovascular risk factor characteristics distributed by gender Risk factors Men Women p value n = 101 % n = 59 % Current smoker 21 20.8 4 6.8 0.019* Physical inactivity 49 48.5 27 45.8 0.737 Diabetes mellitus 21 20.8 21 35.6 0.040* Hypertension 87 86.1 57 96.6 0.033* Hypercholesterolemia 52 51.5 39 66.1 0.072 *Significant p values (between men and women, χ 2 ). analysis similarly revealed significantly higher median HADS-D scores in male (7.5, IQR 5 – 12 vs. 4, IQR 3 – 8, p = 0.002) and female patients (9, IQR 7.25 – 11.75 vs. 8, IQR 4 – 10, p = 0.027) who were hypodynamic. In contrast, the median HADS-A score did not significantly differ between females and males who exercised and did not exercise (p = 0.676) (Table 4). Discussion This study assessed gender differences regarding the associations between emotional disorders and MI that had occurred less than one month before the initial assessment. Our investigation showed that 71.4% of female and 60.4% of male patients had some type of emotional mental health problem after having been diagnosed withMI. Subsequently, we observed an elevated risk of concomitant emotional disorders in women, in comparison to men (p = 0.006). Likewise, a gender-associated difference was displayed by Carvalho et al. who used the same HAD scale and found depression symptoms in 17.5% of adult inpatients with cardiovascular disease and anxiety symptoms in 32.5% and, amongst these, the highest prevalence of mental disorders were also associated with female gender (anxiety: p = 0.002; depression: p = 0.022). 13 Although the incidence of depression in women in society is nearly double than that in men, 14 it is of utmost importance to stress that this gender-based discrepancy in society is quite probably irrelevant to our study, as the mean age of women in our study was 70 years and the incidence of depression in women after menopause (when reproductive hormones stabilize) is similar to that in men. 15 The high prevalence of emotional disorders that we observedmay be partially explained by the fact that we only assessed those with a more severe condition, i.e., MI. A similar study that also used the HAD scale, but assessed dermatological patients in the same region (Vilnius Table 4 – Cardiovascular risk factors and Hospital Anxiety and Depression Scale score Risk factors HADS-A HADS-D Median (interquartile range) Median (interquartile range) Men Women Men Women Current smoker Yes 10 (7.5 – 14) 9 (7.25 – 13) 5 (2 – 11.5) 6 (4 – 11.75) No 6.5 (3 – 9) 8 (5 – 10) 6 (4 – 10) 8 (7 – 11) p value 0.002* 0.311 0.473 0.439 Physical inactivity Yes 7.5 (4 – 11) 7 (5 – 10.75) 7.5 (5 – 12) 9 (7.25 – 11.75) No 7 (3 – 10) 8 (6 – 10) 4 (3 – 8) 8 (4 – 10) p value 0.286 0.364 0.002* 0.027* Diabetes mellitus Yes 7 (4 – 9) 8 (6 – 11) 10 (5 – 11) 9 (7 – 13) No 7 (3 – 11) 8 (5 – 10) 5 (3 – 9.75) 8 (5.75 – 10.25) p value 0.943 0.537 0.043* 0.283 Hypertension Yes 7 (4 – 10) 8 (5.5 – 10.5) 6 (3 – 10) 8 (6.5 – 11) No 6 (2.75 – 10.75) N/A 8 (4.75 – 10.25) N/A p value 0.756 N/A 0.287 N/A Hypercholesterolemia Yes 7 (4 – 9) 8 (6 – 12) 6.5 (4 – 10) 9 (7 – 12) No 8 (3.5 – 12.5) 6.5 (4 – 8) 6 (3 – 10.5) 7 (4 – 8.75) p value 0.2 0.02* 0.859 0.015* *Significant p values. HADS: Hospital Anxiety and Depression Scale; HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression. 679