The MAID study: myocarditis, anxiety, insomnia, and depression

Abstract Background Myocarditis, a non-ischemic inflammatory condition of the myocardium, is often triggered by infectious or immune-mediated mechanisms. While many cases resolve spontaneously with normalization of cardiac function, up to 30% of biopsy-confirmed patients progress to chronic dilated cardiomyopathy. Beyond its physical consequences, the sudden onset, unpredictable course, and functional limitations may provoke considerable psychological stress. This can manifest as anxiety, depressive symptoms, and insomnia—factors that are often underrecognized in the cardiology setting.[1,2] Purpose To evaluate the influence of a myocarditis diagnosis on the severity of depressive, anxiety, and insomnia symptoms in patients referred for cardiac magnetic resonance (CMR) imaging. Methods Sixty patients (38 men, 22 women; mean age 44.3 ± 12.2 years; range 20–64 years) who underwent CMR for suspected myocarditis were prospectively enrolled. Psychological assessment was conducted via structured telephone interviews using validated questionnaires: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Athens Insomnia Scale (AIS). Based on CMR results, patients were divided into three groups: those with active myocarditis (n = 11), patients with a history of myocarditis (n = 30), and patients in whom myocarditis was excluded (n = 19). Results Patients with active myocarditis demonstrated significantly higher levels of depressive and anxiety symptoms compared to the other two groups. In this subgroup, lower left ventricular ejection fraction was associated with greater severity of depressive symptoms. No significant differences were observed between groups regarding insomnia scores as measured by the AIS. Conclusion A diagnosis of active myocarditis is associated with a markedly increased psychological burden, particularly with respect to depression and anxiety. These findings emphasize the importance of comprehensive, multidisciplinary care models that address not only the cardiac but also the emotional and psychological dimensions of myocarditis, especially during the acute and early recovery phases.Graphical abstract