Sex differences in symptoms of anxiety, depression, and post-traumatic stress disorder among cardiac arrest survivors

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Abstract Funding Acknowledgements Type of funding sources: None. Introduction Anxiety, depression, and post-traumatic stress disorder (PTSD) among out-of-hospital cardiac arrest (OHCA) survivors may impact their long-term recovery and quality of life. Gaining knowledge on sex differences in psychological consequences following cardiac arrest is important to explore strategies aiming to reduce these symptoms. Purpose To explore sex differences in anxiety, depression and PTSD levels after discharge among OHCA survivors hospitalized at a cardiovascular intensive care unit. Methods This was a prospective observational study in OHCA survivors that attended a follow-up after 4 months, (median, IQR 3-8). Presence of symptoms of anxiety and depression was measured using Hospital Anxiety and Depression Scale (HADS), range 0-21. Scores between 8 to 10 suggest the possible presence of a mood disorder whereas scores of 11 and above indicate the probable presence of a mood disorder. Symptoms of PTSD were measured with PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report measure that assesses symptoms of PTSD, range 0-80. Results Between 2016 and 2021, 245 consecutive OHCA survivors admitted in coma (44 women, 18% and 201 men, 82%) completed the survey. Mean values measured on HADS were 2.7 ±3.2 for depression and 4.8±3.9 for anxiety. Depression and anxiety levels were significantly higher in women (3.3±3.4 and 6.1±3.8), respectively, compared to men (2.6±3.2 and 4.5± 3.9), respectively (p<0.0001 for both). Anxiety scores of 8 or more were observed in 43% of women, and 23% of men (p=0.007). Scores of 8 to 10 suggesting the possible presence of anxiety were found in 23% of women and 11% of men (p=0.007), whereas one out of five women scored ≥ 11 (20%) indicating probable anxiety disorder, while one in ten of men(12%), (p=0.02). Further, female sex was significantly associated with higher levels of PTSD (median for women: 33, IQR 24-54, and for men 26, IQR 22-35), (p=<0.0001). Finally, anxiety was significantly correlated to post-traumatic stress symptoms (correlation coefficient 0.81, p=<0.0001). Conclusion Symptoms of anxiety and PTSD are frequent in OHCA survivors and female cardiac arrest survivors report significantly higher symptom levels of anxiety, depression, and PTSD compared to men. These results underline the presence of long-term symptoms in these patients and support further research in sex-specific approaches to alleviating these symptoms in patients surviving OHCA.