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

Abstract

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.

The impact of pre-existing anxiety on affective and cognitive processing of a Virtual Reality analogue trauma

“…Our findings revealed that VR analogue trauma exposure leads to higher subjective anxiety in HA individuals than LA individuals in line with Spielberger’s trait-state anxiety model [ 11 ] and with previous studies [e.g.13]. Previous studies have found that individuals with HTA showed a higher risk to develop PTSD, which was classified as anxiety disorder until the change to DSM-5 into a distinct diagnostic group of trauma and stressor-related disorders [ 2 , 3 , 24 ]. Although intense peri-traumatic negative emotions which we have found in our study are considered a natural first stress response upon confrontation with a potentially traumatic event [ 4 , 17 ], increased peri-traumatic anxiety is associated with a higher risk of developing stress-associated symptoms [ 14 ] as well as higher peri-traumatic stress is associated with an increased risk to develop PTSD [ 63 ].…”

“…The modulation of the intensity and duration of emotions is especially important in HA individuals because of their disposition to experience intense and prolonged negative emotional responses [ 18 , 22 ], which is associated with higher rates of psychopathology [ 14 , 23 ]. HA is also associated with the development of PTSD [ 24 , 25 ]. Thus, it is likely that individual differences in HA modulate cognitive and affective stress responses to trauma.…”

Post-traumatic stress disorder among patients waiting for cardiac surgery

“…Such discrepancy may be due to a lack of psychiatric examination in the work of Deng et al [17], where PTSD symptoms were examined based only on self-reported scales and the traumatic event was identified only through a background survey. A similar percent of PTSD symptoms, among a group of 1,125 patients scheduled for cardiac surgery requiring a cardiopulmonary bypass, was reported by Kok et al [18]. Authors showed that PTSD symptoms were present in 10.2% of the group, based on a self-report inventory for PTSD (SRIP) containing 22 items.…”

“…Authors showed that PTSD symptoms were present in 10.2% of the group, based on a self-report inventory for PTSD (SRIP) containing 22 items. Kok et al [18] did not include information about the cause of PTSD symptoms and patients were not evaluated by a psychiatrist to confirm PTSD based on any disease classification. In our work, PTSD frequency was also significantly lower than in the group of American patients with mitral regurgitation (4% vs. 23%) [3].…”

Physiological and Psychological Determinants of Quality of Life for Patients after Cardiac Surgery and the Associated Factors

“…Tulloch and colleague (2013) examine several risk factors have been associated with PTSD after cardiac surgery and can be classified as: cardiac event itself risk factors, the surgical process risk factors, the intensive care environment risk factors, medical and psychological comorbidities risk factors, social support, and Sociodemographic factors [29]. This result supported by a study conducted by Kok and colleagues (2016), to found that being male, older age, medical history, psychiatric history, ICU environment and duration of stay, high risk mortality, coping mechanism, smoking and substance abuse, and trait anxiety considered a significant risk factors that affect the development of PTSD in cardiac surgery patients after long-term follow up [13].…”