Posttraumatic Stress Disorder in the Wake of Heart Disease: Prevalence, Risk Factors, and Future Research Directions

Spindler, Helle; Pedersen, Susanne S.

doi:10.1097/01.psy.0000174995.96183.9b

Cited by 129 publications

(125 citation statements)

References 60 publications

(91 reference statements)

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“…Finally, we did not assess other potentially important predictors of PTSD status such as previous psychiatric disorders and social support. 4 Altogether, we found that PTSD is a clinical disorder with a considerable, high prevalence in the post-MI populations. Psychological variables related to the subjective experience of MI predicted PTSD status better than did objective measures of MI severity.…”

Section: Discussionmentioning

confidence: 68%

“…2,3 Approximately 15% of patients develop posttraumatic stress disorder (PTSD) in the aftermath related to their MI. 1,4 Although a psychiatric disorder, PTSD is increasingly acknowledged as an important clinical entity in cardiovascular medicine. 5 The PTSD is associated with poor compliance with cardiac therapy 6 and poor cardiovascular outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Guler¹,

Schmid

Wiedemar

et al. 2009

Clinical Cardiology

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Background: Clinician-rated large-scale studies estimating the prevalence of posttraumatic stress disorder (PTSD) related to myocardial infarction (MI) and identifying predictors of clinical PTSD are currently lacking. Hypotheses: We hypothesized that PTSD is prevalent in post-MI patients and that the subjective experience of the MI determines PTSD status. Methods: We approached 951 post-MI patients with a questionnaire screening for PTSD symptoms related to their MI. Those responding and meeting a cutoff of PTSD symptom levels were invited to participate in a structured clinical interview to diagnose PTSD following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Fear of dying, feelings of helplessness, and severity of pain perceived during the MI were also assessed by visual analog scales. Results: The screening questionnaire was completed by 394 patients, whereby 77 met the cutoff for the interview (8 patients declined the interview). Forty of 394 patients (10.2%) had clinical PTSD (subsyndromal and syndromal forms combined). Younger age (OR 0.95, 95% CI 0.91-0.99), greater fear of dying (OR 2.77, 95% CI 1.28-5.97), and more intense feelings of helplessness (OR 2.97, 95% CI 1.42-6.21) were independent predictors of PTSD status. Perceived pain intensity during MI, sex, type of index MI, left ventricular ejection fraction, number of coronary occlusions, and highest level of total creatinine kinase were not significant predictors. Conclusions: Clinical PTSD is prevalent in post-MI patients. Demographic and particularly psychological variables related to the subjective experience of the event were stronger predictors of PTSD status than were objective measures of MI severity.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Guler¹,

Schmid

Wiedemar

et al. 2009

Clinical Cardiology

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“…In cardiac surgery patients, psychiatric morbidity is common and an increase of both symptom frequency and severity with regard to PTSD and depression is often reported after discharge (Musselman et al, 1998;Spindler, 2005). Vice-versa, the pathophysiologic progression of cardiovascular disease is influenced by the presence of depression: depressed patients have an increased risk for future cardiac events and mortality (Gold, 2015;Musselman et al, 1998).…”

Section: Stress Exposure During Life and Vulnerability To Psychopathomentioning

confidence: 99%

“…Moreover, it affects fear response circuits and leads to long-lasting alteration in psychophysiological reactivity (Horovitz et al, 2012). Hence, the ability to cope with stressors later in life is hampered and associations with depression and PTSD are often found (Horovitz et al, 2012;Spindler, 2005).…”

Section: Stress Exposure During Life and Vulnerability To Psychopathomentioning

confidence: 99%

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

Kok

Sep

Veldhuijzen

et al. 2016

Journal of Affective Disorders

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a b s t r a c tBackground: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions. Methods: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/ or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes. Results: PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender. Limitations: The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time. Conclusions: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

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“…3 Two recent reviews found that, on average, 15% of patients develop posttraumatic stress disorder (PTSD) post-MI. 4,5 To meet the diagnostic criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 6 the patient must have experienced the MI as an event involving threatened death (criterion A1) to which he or she responded with intense fear, helplessness, or horror (criterion A2). Three characteristic symptom clusters related to reexperiencing the MI (criterion B), avoidance of stimuli associated with the MI (criterion C), and hyperarousal (criterion D) must have persisted for at least one month (criterion E) and have caused clinically significant distress or impairment in daily functioning.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

et al. 2008

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OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/-12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level. PREVALENCE AND PREDICTORS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN ACUTE MYOCARDIAL INFARCTION PATIENTS Methods:We recruited 400 patients (mean age 60±12 years, 79% men) with a previous acute index MI referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale (CAPS) and self-rated severity of PTSD symptom levels by the Posttraumatic Diagnostic Scale (PDS). Results:Of the 190 patients who completed the PDS, 34 met the cut-off for clinically significant PTSD symptomatology and 32 agreed to be interviewed. In these, the CAPS interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% CI 7.4-11.6).Retrospectively rated feelings of helplessness (β=.47, p<.001) and pain intensity during MI (β=.15, p=.019) independently predicted PTSD symptom level.Conclusions: Almost 10% of post-MI patients had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.2

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Posttraumatic Stress Disorder in the Wake of Heart Disease: Prevalence, Risk Factors, and Future Research Directions

Cited by 129 publications

References 60 publications

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

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