MENTAL HEALTH PROBLEMS are common after acute coronary syndrome (ACS), including acute myocardial infarction (AMI), coronary artery bypass surgery (CABGS) and other cardiac events. Recent estimates indicate that one in three cardiac patients will experience clinically significant anxiety and up to one in four will be depressed after an acute coronary event. Approximately 15% will be diagnosed with post-traumatic stress disorder. Heart attack and other cardiac events are also associated with elevated rates of suicide.

Mental health conditions compromise recovery post-event

As well as being distressing for patients and negatively impacting quality of life, these mental health conditions compromise physical recovery and return to normal functioning. Patients with post-event mental health conditions are less likely to take medications as prescribed, are less adherent to lifestyle advice, including increasing physical activity, dietary change and smoking cessation advice, are less likely to attend cardiac rehabilitation (CR) programs.

At the ACHH, we have undertaken many cross-sectional and longitudinal studies to investigate the prevalence of and risk factors for post-event mental health conditions. We have also studied the common patterns of mental health recovery over time.

Who is at risk of post-cardiac mental health conditions?

There are key risk factors or ‘red flags’ for post-event mental health conditions. These include having had a mental health condition prior to the cardiac event, being younger (under age 55), being socially isolated, experiencing financial strain, being a smoker having comorbid health conditions such as diabetes or obesity, and having other concurrent life challenges such as recent bereavement, job loss or relationship breakdown.

Patients with persistent anxiety and depression have increased inflammation and altered autonomic function, poorer functional capacity and an increased risk of recurrent cardiac events and premature mortality.

Treatments for post-event mental health conditions

There are many evidence-based treatments for post-event mental health problems, namely:

  1. Lifestyle approaches such as increasing physical activity, making dietary changes and attending cardiac rehabilitation. There is strong evidence that these approaches can all improve mood and assist in mental health recovery post-event.

  2. Psychological treatments such as cognitive behaviour therapy (CBT), acceptance & commitment therapy (ACT), existential therapy, and mindfulness approaches can all help to improve post-cardiac event mental health by reducing psychological distress, strengthening adaptive coping, and supporting adjustment to the emotional and existential challenges associated with cardiac disease.

  3. In some cases, patients may benefit from psychotropic medications such as antidepressants or anti-anxiety medications for conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD) following a cardiac event. These medications are prescribed by a general practitioner or psychiatrist.

Publications relating to Anxiety and Depression

  1. Ski CF, Jennings C, Thompson DR. Improving the mental health of patients with heart disease. European Journal of Cardiovascular Nursing (2025) 24, 647–651 https://doi.org/10.1093/eurjcn/zvaf057

  2. Le Grande MR, Murphy BM, Jackson AC. Adding psychological risk exposure to improve cardiovascular risk prediction: A commentary. European Journal of Cardiovascular Nursing 2025 Jun 16:zvaf098. doi: 10.1093/eurjcn/zvaf098. Online ahead of print.

  3. Chantal F Ski, David R Thompson, Alun C Jackson, Susanne S Pedersen, Psychological screening in cardiovascular care, European Journal of Cardiovascular Nursing, 2025;, zvaf057, https://doi.org/10.1093/eurjcn/zvaf057

  4. Murphy B, Le Grande M, Jackson A. Supporting mental health recovery in patients with heart disease: a commentary. European Journal of Cardiovascular Nursing. 2025;24(2):205-6.

  5. Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation: Cochrane systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2025;24(2):194-204.

  6. Le Grande MR, Salvacion M, Schwaita L, Murphy BM, Jackson AC, Alvarenga ME. Does coping style mediate the relationship between knowledge and psychosocial outcomes in women with atrial fibrillation? Frontiers in Psychiatry. 2024 Vol. 15, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1328111

  7. Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, Thompson DR. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database of Systematic Reviews 2024, Issue 7. Art. No.: CD013508

  8. Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation: Cochrane systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2024:zvae113.

  9. Khanipour-Kencha A, Jackson AC, Sharifi F, Bahramnezhad F. Death anxiety in patients with a history of coronary artery bypass graft surgery during the COVID-19 pandemic: The role of spiritual well-being and coping strategies. Journal of Religion and Health. 2024; DOI: 10.1007/s10943-024-02003-w

  10. Murphy B, Higgins R, Jackson A. Incidence and impacts of post-cardiac event mental health problems. Australian Journal of General Practice 2023; 52:781-886.  doi: 10.31128/AJGP-05-23-6828  

  11. Murphy BM, Amerena J, Jackson AC. Managing cardiac-related mental health problems: Challenges and solutions, Cardiology Today, 13,2, Oct 2023

  12. Jackson AC, Rogerson MC, Murphy BM. An integrated perspective for understanding the psychosocial impact of acute cardiovascular events: A scoping review. Heart Mind 2023;7:137-47.

  13. Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, Thompson DR. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database of Systematic Reviews. Art. No.: CD013508. DOI: 10.1002/14651858.CD013508.pub3.

  14. Alvarenga M, Murphy BM, Jackson AC. Emerging approaches to the treatment of depression in patients with cardiovascular disease. British Journal of Cardiac Nursing. 2021. https://doi. org/10.12968/bjca.2021.0111

  15. Higgins RO. Supporting patients to make meaning, create connections and live life post cardiac event. British Journal of Cardiac Nursing. 2021. https://doi.org/10.12968/bjca.2021.0125

  16. Murphy B, Phillips L, Jackson AC. Rumination as a key to understanding anxiety and depression in cardiac patients. British Journal of Cardiac Nursing. https://doi. org/10.12968/bjca.2021.0046

  17. O’Neil A, Russell JD, Murphy BM. How does mental health impact women’s heart health? Heart Lung and Circulation, 2021, 30, 1, 59-68

  18. Guan YY, Murphy BM, Phillips L, Crebbin S, Le Grande M, Worcester M, Jackson AC. Impact of rumination on severity and persistence of anxiety and depression in cardiac patients, Heart & Mind, 2021;5:9-16.

  19. Asgari P, Jackson AC, Bahramnezhad F. Adjustment to a new heart: Concept analysis using a hybrid model. Iran J Nurs Midwifery Res 2021; 26:89-96.

  20. Murphy BM, Higgins RO, Jackson AC. The mental health burden of COVID-19 on cardiac healthcare workers and their patients. British Journal of Cardiac Nursing. 2020. https://doi.org/10.12968/ bjca.2020.0129

  21. Callus E, Pagliuca S, Bertoldo EG, Fiolo V, Jackson AC, Boveri S, , De Vincentiis C, Castelvecchio S, Volpe M, Menicanti L. The monitoring of psychosocial factors during hospitalization before and after cardiac surgery until discharge from cardiac rehabilitation: A research protocol, Frontiers in Psychology, DOI: 10.3389/fpsyg.2020.02202

  22. Murphy BM, Higgins RO, Clarke J, Rogerson M, Jackson AC. (2020) Healing the heart after an acute cardiac event Inpsych, 42, 4,

  23. Murphy BM, Le Grande MR, Alvarenga ME, Worcester MU and Jackson AC (2020) Anxiety and Depression after a Cardiac Event: Prevalence and Predictors. Frontiers in Psychology. 10:3010. doi: 10.3389/fpsyg.2019.03010

  24. Worcester MU, Goble AJ, Elliott PC, Froelicher ES, Murphy BM, Beauchamp AJ, Jelinek MV, Hare DL. Mild depression predicts long term mortality after acute myocardial infarction: a 25-year follow-up. Heart Lung and Circulation 2019; 28(12): 1812-18.

  25. Le Grande M., Jackson AC., Ski C.F., Thompson D.R., Brown A. (2019) Depression, Cardiovascular Disease and Indigenous Australians. In: Zangeneh M., Al-Krenawi A. (eds) Culture, Diversity and Mental Health - Enhancing Clinical Practice. Advances in Mental Health and Addiction. Springer

  26. Jackson AC, Murphy BM. Loneliness, social isolation and cardiovascular risk, British Journal of Cardiac Nursing, 2019;14(10)1–8. https://doi.org/10.12968/bjca.2019.0093

  27. Le Grande M, Bunker S, Tucker G, Jackson AC. Validating the SF-12 and the development of disease specific norms in a cohort of Australian private health insurance members, (2019). Australian Journal of Primary Health  https://doi.org/10.1071/PY18069

  28. Baird D, Jackson AC, Higgins RO, Murphy BM, Tully PJ. (2018). Depression screening, assessment and treatment in chronic heart failure, British Jnl of Cardiac Nursing, 13,8,386-393

  29. Jackson AC, Murphy BM. ICD surgery: Highlighting the psychological consequences. British Jnl of Cardiac Nursing, 2017, 12,10,482-486

  30. Le Grande M, Ski CF, Thompson DR, Scuffham P, Kularatna S, Jackson AC, Brown A. Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 2017, 187, 164-173

  31. Saltmarsh N, Murphy BM, Bennett P, Higgins RO ... Jackson AC (2016). Distress in partners of cardiac patients: Relationship quality and social support, British Jnl of Cardiac Nursing, 11, 8, 397-405. DOI: http://dx.doi.org/10.12968/bjca.2016.11.8.397

  32. Ski, C.F., Jelinek, M., Jackson, A.C., Murphy, B.M., Thompson, D.R. (2016). Psychosocial interventions for patients with coronary heart disease and depression: A systematic review and meta-analysis, European Jnl of Cardiovascular Nursing, 15, 5, 305-316. DOI: 10.1177/1474515115613204

  33. Jackson AC, Murphy BM, Ski C F, Thompson DR (2016). Psychosocial interventions for patients after a cardiac event, Handbook of Psychocardiology, (Eds. D. Byrne & M. Alvarenga), Springer Science+Business Media Singapore. DOI: 10.1007/978-981-4560-53-5_47-1

  34. Murphy BM, Higgins RO, Jackson AC (2016). Anxiety, depression and psychological adjustment after an acute cardiac event, Handbook of Psychocardiology, (Eds. D. Byrne & M. Alvarenga), Springer Science+Business Media Singapore. DOI:10.1007/978-981-4560-53-5_57-1

  35. Jobling K*, Lau P*, Kerr D, Higgins RO, Worcester MU, Angus L, Jackson AC, Murphy BM (2016). Bundap Marram Durn Durn: Health service engagement with urban Aboriginal women experiencing comorbid chronic physical and mental health conditions. ANZ Journal of Public Health, 40 (Suppl. 1) S30-S35; doi: 10.1111/1753-6405.12382

  36. Ski, C.F., Jelinek, M., Jackson AC., Murphy, B.M., Thompson, D.R. (2015). Psychosocial interventions for patients with coronary heart disease and depression: A systematic review and meta-analysis, European Jnl of Cardiovascular Nursing, Online doi: 10.1177/1474515115613204

  37. Murphy BM, Ludeman D, Elliott P, Judd F, Humphreys J, Edington J, et al. 'Red flags' for anxiety and depression after an acute cardiac event: 6-month longitudinal study in regional and rural Victoria, European Journal of Preventive Cardiology 2014 Vol. 21 Issue 9 Pages 1079-89, DOI: 10.1177/2047487313493058

  38. Crebbin, S.J., Murphy, B.M., Phillips, L., Jackson AC. (2014). Perception of benefits and psychological growth following a cardiac event: Relationship with anxiety and depression. Global Heart, 9, IS, March, e263.

  39. Murphy BM, Rogerson M, Worcester MUC, Higgins R, Goble A. Predicting mortality 12 years after an acute cardiac event: comparison between in-hospital and 2-month assessment of depressive symptoms in women. Journal of Cardiopulmonary Rehabilitation and Prevention. 2013;33:160-167. doi:10.1097/HCR.013e318283927f

  40. Murphy B, Le Grande M, Navaratnam H, Higgins R, Elliott P, Turner A, Rogerson M. et al. Are poor health behaviours in anxious and depressed cardiac patients explained by sociodemographic factors? European Journal of Preventive Cardiology. 2012; 20(6) 995–1003. doi: 10.1177/2047487312449593.

  41. Le Grande M, Elliott P, Worcester M, Murphy BM, Goble A, Kugathasan V, et al. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients. Psychol Health Med. 2012;17(6):709-722. doi: 10.1080/13548506.2012.66186

  42. Elliott PC, Murphy BM, Oster KA, LeGrande MR, Higgins RO, Worcester MUC. Changes in mood states after coronary artery bypass graft surgery. European Journal of Cardiovascular Nursing 2010;9(3):188-94.

  43. Murphy B, Elliott P, Worcester MU, Le Grande M, Higgins R, Goble A, Roberts S. Trajectories and predictors of anxiety and depression in women following an acute cardiac event. British Journal of Health Psychology 2008;13:135-53.

  44. Murphy BM, Elliott PC, Higgins RO, Le Grande MR, Worcester MU, Goble AJ, et al. Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse, Eur J Cardiovasc Prev Rehabil 2008 Vol. 15 Issue 4 Pages 434-40, DOI: 10.1097/HJR.0b013e3282fbc945

  45. Murphy B, Elliott P, Le Grande M, Higgins R, Ernest C, Goble A, Tatoulis J, Worcester M. Living alone predicts 30-day hospital readmission following coronary artery bypass graft surgery. European Journal of Cardiovascular Prevention and Rehabilitation 2008; 15:210–215.

  46. Higgins R, Murphy B, Nicholas A, Worcester M, Lindner H. Emotional and adjustment issues faced by cardiac patients seen in clinical practice: the health professionals’ perspective. Journal of Cardiopulmonary Rehabilitation 2007;27:291-7.

  47. Worcester MUC, Murphy BM, Elliott PC, Le Grande MR, Higgins RO, Goble AJ, Roberts SB. Trajectory of recovery of health-related quality of life in women after an acute cardiac event.  British Journal Health Psychology 2007;12:1-15.

  48. Le Grande M, Elliott P, Murphy B, Worcester M, Higgins R, Ernest C, Goble A. Health related quality of life trajectories and predictors following coronary artery bypass graft surgery. Health and Quality of Life Outcomes 2006;4:49.

  49. Hosseini A, Jackson AC, Bahramnezhad F. Ethical considerations in interventional studies: A systematic review, Acta Medica Iranica DOI: 10.18502/acta.v60i10.11550