A Five-Country Comparison of Anxiety Early After Acute Myocardial Infarction

Anxiety is common after acute myocardial infarction (AMI) and has the potential to negatively affect physical and psychosocial recovery. There have been no cross-cultural comparisons of anxiety among AMI patients. The objectives of this study were to evaluate whether anxiety after AMI differs across five diverse countries and to determine whether an interaction between country, sociodemographic variables, and clinical variables contributes to variations in reporting anxiety. A total of 912 individuals with confirmed AMI were enrolled in this prospective, comparative, cross-cultural study. Anxiety was assessed within 72 hours of hospital admission using the Brief Symptom Inventory. The mean level of anxiety in the entire sample was 0.62 +/- 0.76, which is 44% higher than the normal mean level. Anxiety levels were not significantly different among the countries studied with the exception that patients in England reported lower levels of anxiety than those in the United States (P=.03). However, this difference disappeared after controlling for sociodemographic variables on which the countries differed. The results show that patients from each country studied experienced high anxiety after AMI. Even though various cultures were represented in this study, culture itself did not account for variations in anxiety after AMI. It appears that anxiety after AMI is a universal phenomenon. Given the potentially negative impact of anxiety on mortality and quality of life after AMI, clinicians and researchers should continue to explore interventions to treat anxiety and minimize its untoward effects. (2 tables, 1 figure, 24 refs.) Prepared in collaboration with the University of California School of Nursing, San Francisco, CA; University of Technology, Sydney, Australia; Tokyo Women's Medical College Hospital, Tokyo, Japan; Yonsei University College of Nursing, Seoul, South Korea; University of Pennsylvania School of Nursing, Philadelphia, PA; Royal Free Hospital, London, England; Ewha Women's University, Seoul, South Korea; and the Department of Health, England.