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An International Perspective on Gender Differences in Anxiety Early After Acute Myocardial Infarction

Moser, Debra K. RN, DNSc; Dracup, Kathleen RN, DNSc; McKinley, Sharon RN, PhD; Yamasaki, Keiko RN, MSN; Kim, Cho-Ja RN, PhD; Riegel, Barbara RN, DNSc; Ball, Carol RN, PhD; Doering, Lynn V. RN, DNSc; An, Kyungeh RN, PhD; Barnett, Maree RN, MSc

doi: 10.1097/01.PSY.0000041543.74028.10

Objective: Higher anxiety is linked to poorer outcomes after acute myocardial infarction (AMI), including increased in-hospital reinfarction and potentially life-threatening complications. If clinicians can identify patients at greatest risk for anxiety after AMI, they can institute early treatment. Previous research on the influence of gender on the incidence of anxiety post-AMI reflects inconsistent findings, and differences across cultures have not been studied. Therefore, the purposes of this study were to determine: 1) whether there are gender differences in anxiety in a diverse international sample of AMI patients, and 2) whether there was an interaction between gender and sociodemographic and clinical variables thought to influence anxiety.

Methods: In this prospective, comparative study, 912 AMI patients were enrolled from Australia, South Korea, Japan, England, and the United States. Anxiety was assessed, using the Brief Symptom Inventory, within the first 72 hours of admission to the hospital for AMI symptoms.

Results: Women had higher anxiety levels than men (0.76 ± 0.90 vs. 0.57 ± 0.70, p =.005), and this pattern of higher anxiety in women was seen in each country studied. Neither sociodemographic nor clinical variables interacted with gender to influence anxiety.

Conclusion: Across a variety of cultures, women have higher anxiety than men after AMI and this relationship is independent of age, education level, marital status, or presence of comorbidities or severity of AMI.

From the College of Nursing (D.K.M.), University of Kentucky, Lexington, Kentucky; the School of Nursing (K.D.), University of California, San Francisco, California; the School of Nursing (L.V.D.), University of California, Los Angeles, California; the School of Nursing (B.R.), San Diego State University, San Diego, California; the University of Technology (S.M.), Sydney, Australia; Tokyo Women's Medical College Hospital (K.Y.), Tokyo, Japan; the College of Nursing (C-J.K.), Yonsei University, Seoul, South Korea; Ewha Womens University (K.A.), Seoul, South Korea; the Royal Free Hospital (C.B.) and City University (C.B.), London, United Kingdom; and the Coronary Heart Disease Policy Team (M.B.), Department of Health, London, United Kingdom.

Address reprint requests to: Debra K. Moser, RN, DNSc, Professor and Gill Chair of Cardiovascular Nursing, University of Kentucky, College of Nursing, Lexington, KY 40536-0232. Email:

Received for publication February 25, 2002; revision received September 3, 2002.

This study was supported by the AACN Sigma Theta Tau Research Grant (D.K.M.); Bennett-Puritan AACN Mentorship (K.A.K., D.K.M.); Sigma Theta Tau; and the Pacific Rim Grant (K.D.).

Copyright © 2003 by American Psychosomatic Society
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