Global Psychological Distress and Risk of Atrial Fibrillation Among Women: The Women's Health Study

Background-Symptoms of psychological distress and depression have been associated with risk of ventricular arrhythmias and sudden cardiac death. Their relationship with atrial arrhythmias, however, is less well studied. Methods and Results-We sought to assess the long-term relations between psychological distress and risk of atrial fibrillation (AF) in the Women's Health Study of female health professionals. We measured psychological symptoms with the Mental Health Inventory-5. Incident AF was assessed annually and verified through medical records. Among 30 746 women without history of cardiovascular disease or AF, 771 cases of AF occurred during a median follow-up of 125 months (interquartile range, 117-130 months). Global psychological distress was not associated with AF risk in age-stratified (P=0.61 for linear trend) or multivariable proportional-hazards models that included antidepressant use (P=0.34). A proxy measure for depression, consisting of Mental Health Inventory-5 score <53, antidepressant use, or both, was also not associated with AF risk in multivariable models (hazard ratio=0.99; 95% confidence interval, 0.78-1.25; P=0.93). In post hoc analyses of individual symptoms from the Mental Health Inventory-5, positive affect, feeling happy some/a good bit of the time, was associated with reduced risk of AF (hazard ratio=0.69; 95% confidence interval, 0.49-0.99; P=0.04); other depressive and anxious symptoms were not. Conclusions-In this prospective study of women without known cardiovascular disease, global psychological distress and specific depressive symptoms were unrelated to AF risk.