The Evolution of the Mental Health-Acute Coronary Syndrome Intersection: A 50-Year Bibliometric Mapping and...

Background/Objectives: The intersection of mental health and acute coronary syndromes has become an increasingly prominent area of cardiovascular and psychosomatic research, yet its temporal dynamics and intellectual structure remain incompletely characterized. Methods: This study analyzed 13,646 peer-reviewed documents spanning five decades, employing advanced changepoint detection (PELT) algorithms, network visualization (VOSviewer), and bibliometric performance metrics (Bibliometrix) to quantify the evolution of the mental health-ACS intersection. Results: Statistical analysis identified two robust inflection points at 1990 and 2005 that demarcate distinct developmental periods. The 1990 breakpoint marked an important transition, although additional metadata-completeness analysis indicated that part of the increase from 72 to 142 publications may reflect improved availability of non-title Topic-field metadata in WoSCC around 1990-1991. The 2005 breakpoint represented the most critical transition (Cohen's d = 4.05, p < 0.000001), initiating exponential growth from 349 to over 600 annual publications by 2022 and coinciding with growing research attention to psychiatric comorbidity within ACS literature. Keyword co-occurrence networks revealed a shift in research focus: early publications predominantly addressed mental health as a psychological reaction to cardiac events, whereas more recent publications increasingly frame depression, anxiety, and PTSD alongside mechanistic constructs such as inflammatory pathways, autonomic dysfunction, and platelet reactivity. Although seminal intervention trials (i.e., ENRICHD, SADHART) established pharmacological safety and symptom improvement, keyword analyses indicate that following these trials, research attention increasingly shifted toward precision psychiatry concepts and mechanistic pathway elucidation. Conclusions: These findings provide a quantitative map of how publication activity at the mental health-ACS intersection has evolved, offering a structured basis for identifying under-researched areas and informing future research agendas.