Table 12.

Psychological distress and risk of AF

Study	Design	Subjects n (% women)	FU, yrs	Psychological distress measures	AF, n (%)	Age-adjusted risk RR (95% CI)	Multivariable-adjusted risk RR (95% CI)
Eaker et al.206 Framingham Offspring Study	Prospective, observational cohort	3682 (52%) Mean age 48.5 (10.1) yrs	10	Type A behaviour Anger Hostility	Women: 62/1908 (3.2%) Men: 132/1750 (7.5%)b	Women: Anger-out 1.3(1.0–1.6); P < 0.05 Men: Trait anger 1.2 (1.0–1.4); P < 0.05 Symptoms of anger 1.2 (1.1–1.4); P < 0.05 Hostility 1.3 (1.1–1.6); P < 0.05	Womena: NS Mena: Trait anger 1.1 (1.0–1.4); P = 0.04 Symptoms of anger 1.2 (1.1–1.4); P = 0.008 Hostility 1.3 (1.1–1.5); P = 0.03
Eaker et al.207 Framingham Offspring Study	Prospective, observational cohort	3682 (52%) Mean age 48.5 (10.1) yrs	10	Tension Anxiety	Women: 62/1908 (3.2%) Men: 132/1750 (7.5%)b	Women:c Men: Tension 1.28 (1.08–1.52) Anxiety 1.16 (1.01–1.33)	Womena: Tension 0.83 (0.63–1.11) Anxiety 1.03 (0.81–1.31) Mena: Tension 1.24 (1.04–1.48) Anxiety 1.10 (0.95–1.27)
Whang et al.208 Women's Health Study	RCT, plus observational follow-up	30 746 women without CVD at baseline Age: ≥45 yrs	10.5	MHI-5d MHI-5 score: 86–100 76–85 53–75 <53	359 235 129 48	Reference 0.86 (0.73–1.02) 0.91 (0.74–1.11) 1.08 (0.80–1.47) P-value for trend 0.61	Reference 0.87 (0.73–1.03) 0.89 (0.72–1.09) 0.99 (0.72–1.35) P-value for trend 0.34

AF, atrial fibrillation; CI, confidence interval; CVD, cardiovascular disease; FU, follow-up; MHI-5, Mental Health Inventory 5-items; NS, not significant in multivariable analyses; RCT, randomized controlled trial; RR, relative risk; SD, standard deviation; yrs, years.

^aAdjusted for age, diabetes, hypertension, history of myocardial infarction or history of congestive heart failure, and valvular heart disease (defined as any diastolic murmur or ≥3 out of 6 systolic murmur).

^bNot reported by each psychological measure.

^cNot reported for women.

^dScore <53 indicates significant global distress.