Psychological recovery after SCAD: Identifying protective and vulnerability factors using cluster analysis

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BACKGROUND: Spontaneous coronary artery dissection (SCAD) is associated with substantial psychological sequelae. Although previous studies have identified individual risk factors for poor mental health post-SCAD, none has examined whether protective and vulnerability factors cluster together. This study aimed to identify distinct post-SCAD psychological profiles. METHOD: A cross-sectional survey of 263 SCAD survivors recruited from the Victor Chang Cardiac Research Institute Arteriopathies and SCAD Cohort (VASC). Participants completed measures of anxiety (GAD-7), depression (PHQ-9), cardiac distress (CDI-SF), health-related quality of life (SF-12), resilience (CD-RISC), social support (ESSI), patient activation (PAM-13), and post-traumatic growth (PTGI), and provided sociodemographic and medical data. K-Prototypes cluster analysis identified subgroups. Between-cluster differences were examined using chi-square tests and ANOVAs. RESULTS: Clustering identified three psychological recovery profiles. Cluster 1 (Psychologically Vulnerable; 39%) comprised younger-to-mid-aged survivors characterised by low resilience, low patient activation, financial strain, and limited social support. Cluster 2 (Established Copers; 32%) were older with moderate-to-high resilience, higher cardiac rehabilitation (CR) attendance, and low financial strain. Cluster 3 (High-Resource Recoverers; 29%), the youngest group, exhibited the highest resilience, patient activation, and post-traumatic growth. Cluster solution validity was supported by convergent evidence across five complementary indices. CONCLUSIONS: Psychological recovery after SCAD is heterogeneous and not necessarily age dependent. Younger survivors who are financially strained and socially unsupported are most vulnerable to poor recovery whereas, in a novel finding, those with favourable personal and social conditions cope well. Among older survivors, financial security and CR attendance may be protective. Interventions should prioritise resilience building, patient engagement, and strengthening social support.

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