Sex differences in symptoms of anxiety, depression, post-traumatic stress disorder, and cognitive function among survivors of out-of-hospital cardiac arrest

Anxiety, depression, and post-traumatic stress disorder (PTSD) among out-of-hospital cardiac arrest (OHCA) survivors may impact long-term recovery. Coping and perception of symptoms may vary between sexes. The aim was to explore sex differences in psychological consequences following OHCA.

This was a prospective observational study of OHCA survivors who attended a structured 3-month follow-up. Symptoms of anxiety/depression were measured using the Hospital Anxiety and Depression Scale, range 0–21, with a cut-off score of ≥8 for significant symptoms; PTSD was measured with the PTSD Checklist for DSM-5 (PCL-5), range 0–80. A score of ≥33 indicated PTSD symptoms. Cognitive function was assessed by the Montreal Cognitive Assessment. From 2016 to 2021, 381 consecutive comatose OHCA survivors were invited. Of these, 288 patients (76%) participated in the follow-up visit [53 (18%) females out of 80 survivors and 235 (82%) males out of 300 alive at follow-up (78%)]. Significant symptoms of anxiety were present in 47 (20%) males and 19 (36%) females (P = 0.01). Significant symptoms of PTSD were present in 30% of males and 55% of females (P = 0.01). Adjusting for pre-specified covariates using multivariable logistic regression, female sex was significantly associated with anxiety [odds ratio (OR): 2.18, confidence interval (CI): 1.09–4.38, P = 0.03]. This difference was especially pronounced among young females (below median age, OR_adjusted: 3.31, CI: 1.32–8.29, P = 0.01) compared with young males. No significant sex difference was observed for depression or cognitive function.

Symptoms of anxiety and PTSD are frequent in OHCA survivors, and female survivors report significantly more symptoms of anxiety and PTSD compared with males. In particular, young females were significantly more symptomatic than young males.