{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:46:36Z","timestamp":1782819996769,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Stress and Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Takotsubo syndrome (TTS), or \u2018broken heart\u2019 syndrome, is an acute, reversible cardiomyopathy classically linked to emotional stress. Although physiological mechanisms have been extensively described, the psychological stress profile of patients with TTS remains incompletely synthesised. This study aimed to systematically review and meta\u2010analyse observational studies examining psychological stress\u2010related factors in patients with TTS compared with cardiac and non\u2010cardiac control groups. We searched PubMed\/MEDLINE, Embase, PsycINFO, Scopus, and Web of Science from 1 January 2011 to 31 March 2024 for observational studies of adults with TTS that used validated psychological assessments and included a cardiac or non\u2010cardiac comparison group. Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Newcastle\u2013Ottawa Scale. Random\u2010effects meta\u2010analysis pooled odds ratios (ORs) for study\u2010defined binary psychological endpoints, and comparator\u2010group subgroup analyses were treated as main analyses. Sixteen studies met the inclusion criteria, comprising 1133 patients with TTS and 1396 controls, including 1061 cardiac controls and 335 non\u2010cardiac controls. Across studies, patients with TTS showed higher rates of acute emotional triggers, lifetime mood and anxiety disorders, trauma history, maladaptive personality traits (e.g.,\u00a0neuroticism and Type D personality), and broader psychological distress, including posttraumatic stress symptoms, sexual distress, and reduced quality of life. The pooled OR for overall psychological morbidity\/stress exposure was 6.50 (95% CI: 3.14\u201313.49), with substantial heterogeneity (\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a084.1%). Comparator\u2010category subgroup analyses showed larger effects against acute coronary syndrome\/acute myocardial infarction controls than against healthy volunteers alone. TTS is strongly associated with both acute emotional stressors and chronic psychological vulnerability, supporting models that conceptualise the syndrome as an extreme stress response of the cardiovascular system. These findings reinforce the value of routine psychosocial assessment and stress\u2010focused interventions in the care of patients with TTS.\n                  <\/jats:p>","DOI":"10.1002\/smi.70182","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:55:06Z","timestamp":1779173706000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Role of Psychological Stress in TAKOTSUBO CARDIOMYOPATHY: The \u2018Broken Heart\u2019 Syndrome"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-3361","authenticated-orcid":false,"given":"Ghada","family":"Shahrour","sequence":"first","affiliation":[{"name":"Faculty of Nursing Jordan University of Science and Technology  Irbid Jordan"},{"name":"RAK College of Nursing RAK Medical and Health Sciences University  Ras Al Khaimah UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2762-3350","authenticated-orcid":false,"given":"Fatma M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"RAK College of Nursing RAK Medical and Health Sciences University  Ras Al Khaimah UAE"},{"name":"Faculty of Nursing Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5518-0892","authenticated-orcid":false,"given":"Mohamed Hussein Ramadan","family":"Atta","sequence":"additional","affiliation":[{"name":"Psychiatric and Mental\u2010Health Nursing Department Faculty of Nursing Alexandria University  Alexandria Egypt"},{"name":"Nursing Department College of Applied Medical Sciences Prince Sattam Bin Abdulaziz University  Wadi Addawasir Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","unstructured":"Ali S. S. M.Aldighly L.Al Othman A.Mikaeel D. H.Ali andR.Jbeily.2025. \u201cKnowledge and Awareness About Broken Heart Syndrome (Takotsubo Cardiomyopathy): A Cross\u2010Sectional Survey From a Syrian Population.\u201dhttps:\/\/doi.org\/10.21203\/rs.3.rs\u20106169930\/v1.","DOI":"10.21203\/rs.3.rs-6169930\/v1"},{"issue":"2","key":"e_1_2_7_3_1","article-title":"Pathogenic Mechanisms of Takotsubo Cardiomyopathy or Broken Heart Syndrome","volume":"11","author":"Borisute D. 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