Abstract 4145226: Sex Differences in Associations Between Adverse Childhood Experiences, Psychological Distress and Health Status in Patients with Recent Myocardial Infarction

Introduction: Adverse childhood experiences (ACEs) are associated with psychological distress in adulthood and increased cardiovascular disease (CVD) risk. Less is known about these relationships in patients with established CVD. Objective: To examine associations between ACEs and psychological distress and disease-specific health status in adults with recent myocardial infarction (MI). We hypothesized that MI patients with higher ACE exposure will report greater distress and poorer health status with stronger associations in women than men. Methods: We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Five ACEs were assessed: living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Outcomes were elevated perceived stress (PSS4 ≥6) and depressive symptoms (PHQ2 ≥3) and disease-specific health status (Seattle Angina Questionnaire [SAQ7 summary score]). We used chi-square tests, t-tests and linear regression to test univariate and multivariate associations, overall and by sex. Results: The 143 participants (36.4% women, mean age 61.5 years [SD=13.4]) completed questionnaires at median 40.5 days post-MI (IQR=22-64.5). At least one ACE was reported by 51% of participants (53.8% women vs. 46.2% men, p=0.73). Women had somewhat poorer health status than men (69.2±22.8 vs. 74.5±18.8; p=0.07) but similar rates of elevated stress (64.7% vs. 51.7%, p=0.16) and depressive symptoms (21.6% vs. 16.9%, p=0.51). Women with ≥1 ACE had poorer health status (62.6 vs. 77.1, p=0.01) and higher rates of elevated stress (78.6% vs. 47.8%, p=0.02) and depressive symptoms (32.1% vs. 8.7%, p=0.04) than those without ACEs; there were no associations in men. After adjusting for age, body mass index, time since MI and participation in cardiac rehabilitation, greater ACEs exposure (0-5) was associated with poorer health status in women (B=-7.2, SE=2.4, p=0.005) but not in men (B=1.9, SE=2.2, p=0.38); the association in women was reduced when further adjusting for PSS4 and PHQ2 scores (B=-3.7, SE=2.8, p=0.20), suggesting a possible mediating effect of distress. Conclusions: Higher ACE exposure is associated with greater psychological distress and worse disease-specific health status in women post-MI. These associations were not observed in men despite similar levels of ACE exposure. ACEs screening may help identify women who could benefit from psychosocial support after MI.