Stress in Women with Acute Myocardial Infarction: A Closer Look

Abstract Background: Women seem to be more susceptible to psychosocial stress than men, and stress is associated with worse outcomes after acute myocardial infarction (AMI). Objectives: To investigate whether the female gender is an independent predictor of risk for stress and to compare stress levels between women and men after AMI. Methods: Cross-sectional study of a case series. Patients aged 18 to 65 years who were treated for AMI at the study facility between January 2017 and June 2018 were eligible. The presence of stress was assessed using Lipp's Stress Symptoms Inventory for Adults (ISSL), which categorizes stress into four phases (alertness, resistance, near-exhaustion, and exhaustion), through a list of physical and psychological symptoms. Data were analyzed using SPSS Version 24.0. The significance level was set at p<0.05. Results: Of the 330 respondents, 89% of women and 70% of men experienced stress. The female gender was associated with nearly threefold higher odds of experiencing stress (EXP (B)2.79, p = 0.02). Regarding the phases of stress, women were more often in the near-exhaustion and exhaustion phases, while men were more often in the resistance phase. Conclusions: This study showed that women are most often in the third and fourth phases of stress, i.e., in situations of long-standing psychosocial stress. These findings can assist in the development of gender-specific strategies for health promotion and disease prevention, aiming to minimize the effects of stress in this population.

摘要 背景：相较于男性，女性对社会心理应激的易感性更高，且应激与急性心肌梗死（acute myocardial infarction, AMI）患者的不良临床预后显著相关。目的：明确女性性别是否为应激发生风险的独立预测因子，并对比急性心肌梗死患者中女性与男性的应激水平差异。方法：本研究为病例系列横断面研究。纳入2017年1月至2018年6月期间，在本研究机构接受急性心肌梗死治疗、年龄介于18至65岁的患者作为研究对象。采用李普成人应激症状量表（Lipp's Stress Symptoms Inventory for Adults, ISSL），通过一系列躯体与心理症状条目，评估研究对象的应激状态；该量表将应激进程划分为四个阶段：警觉期、抵抗期、耗竭前期与耗竭期。数据分析采用SPSS 24.0统计软件完成，检验水准设定为p<0.05。结果：共纳入330名研究对象，其中89%的女性与70%的男性存在应激症状。女性发生应激的优势比为2.79，即发生应激的风险约为男性的2.79倍（EXP(B)=2.79, p=0.02），差异具有统计学意义。在应激分期分布上，女性更多处于耗竭前期与耗竭期，而男性则更多处于抵抗期。结论：本研究结果显示，女性更常处于应激的第三、第四阶段，即长期持续的社会心理应激状态。上述研究结果可为制定针对性别差异的健康促进与疾病预防策略提供依据，以期减轻该人群所受应激的负面影响。