title: Change over time in posttraumatic stress caused by myocardial infarction and predicting variables.
abstract: OBJECTIVE
  The traumatic experience of a heart attack may evolve into symptoms of posttraumatic stress disorder, which can be diagnosed at the earliest 1 month after myocardial infarction (MI). While several predictors of posttraumatic stress in the first year after MI have been described, we particularly sought to identify longer-term predictors and predictors of change in posttraumatic stress over time.
  
  
  METHODS
  We studied 274 post-MI patients with complete data (mean 61+/-10 years, 84% men). After a median of 60 days (range 30-365) following the index MI (study entry), they were asked to rate MI-related posttraumatic stress as well as psychological distress perceived during MI. After a median of 32 months (range 19-45) later, all patients were asked to rate posttraumatic stress again (follow-up).
  
  
  RESULTS
  Female gender (P=.038) as well as greater helplessness (P<.001) and pain (P=.049) during MI predicted greater posttraumatic stress at study entry. Greater posttraumatic stress at follow-up was predicted by greater posttraumatic stress at study entry (P<.001), shorter duration of follow-up (P=.046), and greater pain during MI (P=.030). The decrease in posttraumatic stress over time (P<.001) was greater in patients with greater posttraumatic stress at study entry (P<.001) and in those with less pain during MI (P=.032).
  
  
  CONCLUSIONS
  Demographic characteristics and perceived distress during MI were predictors of shorter-term posttraumatic stress. Although posttraumatic stress decreased over time and strongest in patients showing the greatest levels initially, greater short-term posttraumatic stress predicted maintenance of posttraumatic stress. Intense pain during MI adversely impacted both longer-term posttraumatic stress and its recovery.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Hari
authors.forename: Stefan
authors.initials: S
authors.lastname: Begré
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Gander
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001293:Attitude to Death; D005260:Female; D005500:Follow-Up Studies; D006380:Helplessness, Learned; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009203:Myocardial Infarction / Q000523:psychology*; D010146:Pain / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*; D011795:Surveys and Questionnaires