title: Clinical diagnosis of posttraumatic stress disorder after myocardial infarction.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Cardiovascular Prevention and Rehabilitation, Department of General Internal Medicine, Bern University Hospital, Inselspital, and University of Bern, Bern, Switzerland.
authors.forename: Erika
authors.initials: E
authors.lastname: Guler
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Lina
authors.initials: L
authors.lastname: Wiedemar
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D015995:Prevalence; D011594:Psychometrics; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires