Psychological Distress and Health Status Perception in Patients With a Previous Myocardial Infarction or Stroke

Introduction: While understanding the impact of mental health on health status perception improves patient-centered care, this relationship is not well-established in cardiac patients. We examined the association between psychological distress and health status perception in patients with a previous myocardial infarction (MI) and/or stroke. Methods: We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported and grouped as poor/fair (0) or good/very good/excellent (1). Anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8) and grouped based on severity. Multivariable logistic regressions controlling for sex, age, education level, smoking status, race, and BMI were performed to assess our hypothesis that higher GAD-7 and PHQ-8 scores are associated with worse health perception in patients with a previous MI/stroke. Results: Of 31,948 individuals for whom data on MI/stroke was available, 6.8% (n=2,181) reported a previous MI and/or stroke. Of these patients, 36.6% (n=799) had scores consistent with anxiety and/or depression on the GAD-7 or PHQ-8. The odds of reporting good/very good/excellent health status were lower for individuals with anxiety (OR 0.245, 95% CI = 0.192-0.314, P <0.001) or depression (OR 0.243, 95% CI = 0.197-0.298, P <0.001) compared to those without anxiety/depression. Increasing severity of anxiety/depression was also associated with worse perception of health status ( Table 1 ). Respondents identifying as “Black” or “Other” race and those with lower education levels also demonstrated significantly worse perceived health status. Conclusion: Patients with previous MI/stroke and concomitant psychological distress have worse perception of health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care.