Post-traumatic stress disorder in patients with cardiac disease: predicting vulnerability from emotional responses during admission for acute coronary syndromes.
OBJECTIVE
To assess frequency and predictors of post-traumatic stress disorder (PTSD), measured by the Post Traumatic Stress-self report version, at three months after admission for acute coronary syndromes (ACS).


METHODS
Two-phase prospective study.


METHODS
Four coronary care units.


METHODS
135 patients admitted to hospital with ACS confirmed by ECG and cardiac enzyme changes.


RESULTS
20 patients (14.8%) showed a symptom pattern characteristic of PTSD at three months assessed by a conservative scoring criterion. Severity of chest pain and psychological factors during admission were predictive of PTSD severity. Acute stress symptoms, depression, negative affect, hostility, and pain scores were independent predictors of three-month PTSD symptoms (R(2) = 0.495, p < 0.001). In contrast, demographic factors (age, sex, education level and income) were unrelated to post-traumatic symptoms, as were markers of clinical disease severity.


CONCLUSIONS
Patient vulnerability to PTSD three months after ACS is predictable on the basis of psychological state and chest pain at the time of admission. This may be valuable to the clinician, as PTSD after myocardial infarction is associated with poorer quality of life, reduced adherence to drug treatment and increased likelihood of cardiovascular morbidity.
Whitehead
D L
DL
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. daisy.whitehead@ucl.ac.uk
Perkins-Porras
L
L
Strike
P C
PC
Steptoe
A
A
D003866:Depressive Disorder / Q000209:etiology*; D004644:Emotions; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D011446:Prospective Studies; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*