Educational Disparities in the Impact of Suicidal Ideation on Long-Term Cardio-Cerebrovascular Outcomes: A Prospective Cohort Study.

IF 2 4区医学 Q3 PSYCHIATRY

Psychiatry Investigation Pub Date : 2026-06-01 Epub Date: 2026-06-08 DOI:10.30773/pi.2025.0434

Hee-Ju Kang, Ju-Wan Kim, Sung-Wan Kim, Joon-Tae Kim, Man-Seok Park, Min-Chul Kim, Youngkeun Ahn, Myung Ho Jeong, Jae-Min Kim

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引用次数: 0

Abstract

Objective: This study investigated whether educational attainment independently predicts long-term prognosis following acute coronary syndrome (ACS) and stroke, and whether this association is modified by acute-phase suicidal ideation (SI).

Methods: Data from two prospective cohorts (1,152 ACS; 396 stroke) were analyzed. Educational attainment (low ≤10 high vs. high >10 years) and SI were assessed approximately 2 weeks post-event. Primary endpoints-major adverse cardiac events (MACE) for ACS and cerebro-cardiovascular events (CCVE) for stroke-were ascertained over a 5-14 year follow-up. Hierarchical Cox models sequentially adjusted for vascular factors (Model 1), psychosocial/disease severity (Model 2), and combined covariates (Model 3). Sensitivity analyses used a ≥12-year education cutoff.

Results: Educational attainment was not an independent predictor of outcomes in either cohort across all models. However, a significant education×SI interaction emerged for MACE in the ACS cohort across all models (p=0.031-0.046). Among ACS patients with SI, higher education was associated with significantly reduced MACE risk (hazard ratio [HR]=0.54, 95% confidence interval 0.34-0.86, p=0.009), while no association existed without SI (HR=1.05, p=0.690). Similar interaction patterns in the stroke cohort achieved significance in Models 1 and 3, though stratified effects were attenuated, likely reflecting limited statistical power. Sensitivity analyses demonstrated directional consistency in both cohorts with some attenuation in fully adjusted models.

Conclusion: Educational background modifies the prognostic impact of psychological distress in post-ACS patients. Lower-educated patients experiencing SI represent a high-risk subgroup requiring targeted psychosocial intervention. These findings support integrating educational status into psychosocial risk stratification protocols for acute cardiovascular care.

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自杀意念对长期心脑血管预后影响的教育差异：一项前瞻性队列研究。

目的：本研究探讨教育程度是否能独立预测急性冠脉综合征（ACS）和脑卒中后的长期预后，以及这种关联是否被急性期自杀意念（SI）所改变。方法：对来自两个前瞻性队列（1152例ACS患者；396例卒中患者）的数据进行分析。教育程度（低≤10高vs高bbb 10年）和SI在事件发生后约2周进行评估。主要终点- ACS的主要不良心脏事件（MACE）和卒中的脑血管事件(CCVE) -在5-14年的随访中确定。分层Cox模型依次调整血管因素（模型1）、社会心理/疾病严重程度（模型2）和组合协变量（模型3）。敏感性分析采用≥12年教育年限。结果：在所有模型中，受教育程度都不是结果的独立预测因子。然而，在所有模型的ACS队列中，MACE出现了显著的education×SI相互作用（p=0.031-0.046）。在ACS合并SI的患者中，高学历与MACE风险显著降低相关（风险比[HR]=0.54, 95%可信区间0.34 ~ 0.86,p=0.009），未合并SI的患者无相关（HR=1.05, p=0.690）。在模型1和模型3中，卒中队列中类似的相互作用模式具有显著性，尽管分层效应减弱，可能反映了有限的统计效力。敏感性分析显示两个队列的方向一致，在完全调整的模型中有一些衰减。结论：学历对acs后患者心理困扰的预后有影响。受教育程度较低的SI患者是需要有针对性的社会心理干预的高危亚群。这些发现支持将教育状况纳入急性心血管护理的社会心理风险分层方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychiatry Investigation PSYCHIATRY-

CiteScore

4.10

自引率

3.70%

发文量

105

审稿时长

6-12 weeks

期刊介绍： The Psychiatry Investigation is published on the 25th day of every month in English by the Korean Neuropsychiatric Association (KNPA). The Journal covers the whole range of psychiatry and neuroscience. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and management of neuropsychiatric disorders and symptoms, as well as researches related to cross cultural psychiatry and ethnic issues in psychiatry. The Journal publishes editorials, review articles, original articles, brief reports, viewpoints and correspondences. All research articles are peer reviewed. Contributions are accepted for publication on the condition that their substance has not been published or submitted for publication elsewhere. Authors submitting papers to the Journal (serially or otherwise) with a common theme or using data derived from the same sample (or a subset thereof) must send details of all relevant previous publications and simultaneous submissions. The Journal is not responsible for statements made by contributors. Material in the Journal does not necessarily reflect the views of the Editor or of the KNPA. Manuscripts accepted for publication are copy-edited to improve readability and to ensure conformity with house style.