Posttraumatic stress disorder in the wake of heart disease: prevalence, risk factors, and future research directions.
BACKGROUND
There is increasing recognition that patients after a cardiac event may be at risk of posttraumatic stress disorder (PTSD). The present article reviews studies looking at PTSD as a sequel of heart disease with a focus on prevalence, risk factors, and future research directions.


METHODS
We conducted a search on PsychInfo and MEDLINE from 1980 to the present. Studies were included in the review if they looked at PTSD after a cardiac event, reported on the number of cases with PTSD, and had been published in English.


RESULTS
We identified 25 studies that fulfilled the inclusion criteria, of which 7 reported on the follow-up of previously published studies. The prevalence of PTSD after heart disease varied from 0% to 38% across studies. PTSD has been most rigorously researched after myocardial infarction with the best-powered studies finding a prevalence rate of 15%. Studies including control groups showed that cardiac patients were at risk of developing PTSD. Risk factors included sociodemographic and psychological characteristics and aspects related to the cardiac event.


CONCLUSIONS
Despite substantial heterogeneity in the methodology of studies and differences in prevalence across studies, this review indicates that subgroups of patients are at risk of PTSD after a cardiac event. Future studies investigating PTSD as a sequel of heart disease should be more systematic, use a prospective study design with multiple assessments, and include sufficiently large samples. PTSD should not be ignored as a sequel of heart disease, given preliminary evidence that PTSD may be associated with nonadherence with medication and an increased risk of clinical adverse events.
Spindler
Helle
H
Institute of Psychology, Aarhus University, Denmark. hellesp@psy.au.dk
Pedersen
Susanne S
SS
D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011379:Prognosis; D012107:Research Design / Q000592:standards / Q000639:trends; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D016312:Treatment Refusal