Engulfed or enriched? illness identity and mental health among Canadian and Australian patients after SCAD
L Maukel, B Murphy, S Mulvagh, M Madan, C Pacheco, J Saw, S Liu, A Paquin, S Hesselson, M Rogerson, S E Iismaa, J C Kovacic, R M Graham, A C Jackson, H TullochAbstract
Background
Spontaneous coronary artery dissection (SCAD), an increasingly recognized cause of acute coronary syndrome that predominantly affects women, is associated with persistent psychological distress and difficulties in life adjustment. Illness identity, the extent to which a health condition becomes integrated into one’s sense of self, predicts mental health outcomes in other chronic illness populations but has not been studied in SCAD.
Purpose
This study examined whether illness identity is associated with symptoms of anxiety and depression in SCAD patient-samples from Canada and Australia.
Methods
Data were drawn from the Canadian MINDSET study and the Australian ACHH psychosocial sub-study of the VCCRI Arteriopathies and SCAD Cohort (VASC), both assessing psychological outcomes post SCAD. Adults diagnosed with SCAD within 3 years were included. Participants completed sociodemographic questionnaires and validated measures, including the Illness Identity Questionnaire (IIQ, engulfment, rejection, acceptance, enrichment, see Figure 1), the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Between-country differences were assessed with chi-square tests, independent-samples t-tests, and ANCOVA for anxiety and depression, controlling for time since diagnosis. Multiple linear regression examined associations between illness identity dimensions, anxiety and depression, adjusting for age, sex, time since diagnosis, and country.
Results
Participants included 323 individuals from Canada and 126 from Australia (N=449, 93% female; mean age = 54 years; 47% within one year of SCAD, see Table 1). Clinically significant symptoms were observed in 19% for generalized anxiety and 23% for depression. Canadian and Australian patients did not differ significantly in anxiety, depression, or any of the four illness identity subscales. In adjusted models, higher engulfment (B=2.64, p<.001) and rejection (B=0.76, p=.011) were significantly associated with anxiety symptoms. Similarly, higher engulfment (B=2.57, p<.001), rejection (B=1.14, p<.001), and lower enrichment (B=-1.33, p<.001) were significantly associated with depressive symptoms. Younger age was associated with both anxiety and depression, while female sex was associated with depression only.
Conclusions
Illness identity dimensions, particularly engulfment and rejection are key correlates of anxiety and depression in SCAD, consistent across the international cohorts. These findings underscore the importance of assessing and addressing illness identity in SCAD psychological care and support global efforts to improve mental health interventions for this population.Picture 1. Illness IdentityTable 1.Patient Characteristics