{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:03:35Z","timestamp":1780401815764,"version":"3.54.1"},"reference-count":58,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Younger and middle-aged women may continue to describe psychological and psychosocial burden years after myocardial infarction (MI), yet multicenter real-world data remain limited on what women retrospectively report during long-term follow-up. This study examined such reports in younger and middle-aged women with prior MI while explicitly accounting for delayed, heterogeneous follow-up timing and the non-standardized nature of symptom ascertainment. Materials and Methods: We performed a cross-sectional analysis within a Croatian multicenter cohort of 957 women younger than 60 years hospitalized with STEMI or NSTEMI between 1 February 2020 and 28 February 2025. Psychological information was collected retrospectively during routine follow-up; the formal PHQ-4 instrument was not administered. A study-specific four-item summary informed by PHQ-4 content was described, and exploratory multivariable analyses modelled this summary as a continuous variable. Descriptive timing-stratified sensitivity analyses and a timing-restricted continuous-score sensitivity model were additionally performed. Results: Prior psychiatric diagnosis was recorded in 16.0% of women, post-MI psychiatric diagnosis in 31.4%, and any psychosocial stressor in 73.2%. Among women with complete item responses, the four-item summary showed a broad distribution rather than a discrete threshold pattern. In continuous-score analyses, higher observed summary values were associated with younger age, prior psychiatric diagnosis, any psychosocial stressor, non-partnered status, non-employment, pregnancy complications\/adverse pregnancy outcomes, and greater peri-menopausal symptom burden. Median summary values were only modestly higher in the small \u2264 1-year stratum and were otherwise similar across the later follow-up strata. Higher summary values were also associated with lower odds of self-reported regular current statin-based lipid-lowering use. Conclusions: These findings are best interpreted as exploratory data on retrospectively reported and currently endorsed long-term psychological and psychosocial burden years after MI, not as contemporaneous measures of recovery-phase psychopathology. Prospective studies with predefined assessment windows and validated instruments are needed.<\/jats:p>","DOI":"10.3390\/medicina62061082","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:14:57Z","timestamp":1780395297000},"page":"1082","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Burden and Psychosocial Stress in Younger and Middle-Aged Women with Prior Myocardial Infarction"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4351-1102","authenticated-orcid":false,"given":"Mira","family":"Stip\u010devi\u0107","sequence":"first","affiliation":[{"name":"Department of Cardiology, General Hospital Zadar, 23000 Zadar, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-9691","authenticated-orcid":false,"given":"Ivana","family":"Jurin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Kne\u017eevi\u0107 Prave\u010dek","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Hospital Dr. Josip Ben\u010devi\u0107, 35000 Slavonski Brod, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-6489","authenticated-orcid":false,"given":"Kristina","family":"Selthofer-Relati\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia"},{"name":"Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Dra\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Centre Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Lugari\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ognjen","family":"\u010can\u010darevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Sveti Duh Clinical Hospital, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9526-3393","authenticated-orcid":false,"given":"\u0160ime","family":"Manola","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3768-9134","authenticated-orcid":false,"given":"Irzal","family":"Had\u017eibegovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-7271","authenticated-orcid":false,"given":"Kristina Mari\u0107","family":"Be\u0161i\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-9904","authenticated-orcid":false,"given":"Luka","family":"Matej Mahe\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Merkur University Hospital, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2115-2826","authenticated-orcid":false,"given":"Vedran","family":"Radoni\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Merkur University Hospital, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Pavlovi\u0107","sequence":"additional","affiliation":[{"name":"Zagreb-Centre Health Centre, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4689-1673","authenticated-orcid":false,"given":"Tomislav","family":"Kr\u010dmar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9428-454X","authenticated-orcid":false,"given":"Matias","family":"Trbu\u0161i\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Cardiology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4156","DOI":"10.1093\/eurheartj\/ehaf191","article-title":"2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: Developed under the auspices of the ESC Clinical Practice Guidelines Committee","volume":"46","author":"Bueno","year":"2025","journal-title":"Eur. 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