Date of Award

12-2022

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Muhammad Masood Kadir

Second Advisor

Syed Iqbal Azam

Third Advisor

Dr. Khawar Abbas Kazmi

Department

Community Health Sciences

Abstract

Background: The burden of anxiety in Pakistan has been reported to range between 18.0% and 57.7%. Low socioeconomic status (SES) has been associated with a greater risk of mental disorders. Approximately 40% of Pakistanis live in poverty. Compromised healthcare owing to out-ofpocket expenses contributes to compromised patient mental well-being. Myocardial infarction (MI) patients require long-term hospital care, the cost of which may take a substantial toll on their mental health. Anxiety, a condition that has been proven to worsen prognostic outcomes in patients with cardiovascular disease (CVD), is one of the most frequently encountered mental health disorders in post-MI patients with a reported prevalence ranging from 9.6% to 69.17%, as per a 2022 meta-analysis. Our study aimed to explore the association between anxiety and SES in patients with a recent history of first MI.
Methods: A cross-sectional study was employed to measure the association between the level of anxiety and SES in post-MI patients. The study was conducted in the cardiology outpatient clinics of two tertiary care hospitals in Karachi, Pakistan. Adult patients who experienced their first MI episode not more than 6 months back were recruited using purposive sampling. The calculated sample size for the study was 179 from both study centers. A composite variable was devised to assess the participants’ SES and was analyzed using exploratory factor analysis. Anxiety level assessment was done using the Beck Anxiety Inventory (BAI). Multiple ordinal logistic regression was used to analyze the association between the level of anxiety, SES, and other factors. Ethical approval was acquired from both institutions.
Results: A total of 140 MI patients were recruited from both study centers. Nearly two-thirds of the study sample constituted males (n = 92; 65.7%) with an average age of 61.1 (SD = 11.96) years. Nearly half of the participants (n = 63; 45%) reported mild to moderate anxiety and 57.14% of the study sample belonged to a low SES background (n = 80). The results of our study noted that patients hailing from a middle SES background had nearly twice (OR = 1.84; 95% CI = 0.65 – 5.21) the odds of presenting with moderate to severe anxiety as compared to patients hailing from a high SES background after controlling for other variables. An interaction term between the variables of hypertension and gender concluded that the odds of a female with hypertension presenting with moderate to severe anxiety were 4 (OR = 4, 95% CI = 2.06 – 7.70) times the odds of a male without hypertension presenting with moderate to severe anxiety.
Conclusion: The results of our study concluded that MI patients from a middle SES background were most likely to present with higher anxiety levels. Mental health interventional strategists and policymakers must extensively explore the influence of SES on physical and mental well-being. Further research is needed in the area to understand the influence of SES on mental healthrelated outcomes in populations as sensitive as post-MI patients.

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