title: Posttraumatic growth in coronary artery disease outpatients: relationship to degree of trauma and health service use.
abstract: OBJECTIVE
  Posttraumatic growth (PTG) is frequently reported after the strike of a serious medical illness. The current study sought to: 1) assess the relationship between degree of cardiac "threat" and PTG one-year post-hospitalization; and 2) to explore the association between PTG and healthcare utilization.
  
  
  METHODS
  In a cohort study, 2636 cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey; clinical data were extracted from charts. One year later, 1717 of these outpatients completed a postal survey, which assessed PTG and healthcare utilization. Morbidity data were obtained retrospectively through probabilistic linkage to administrative data. The predicted risk of recurrent events for each participant was calculated using a logistic regression model, based on participants' sociodemographic and clinical characteristics. The relationship among PTG, trauma and health service use was examined with multiple regression models.
  
  
  RESULTS
  Greater PTG was significantly related to greater predicted risk of recurrent events (p<0.001), but not the actual rate of recurrent events (p=0.117). Moreover, greater PTG was significantly related to more physician visits (p=0.006), and cardiac rehabilitation program enrolment (p=0.001) after accounting for predicted risk and sociodemographic variables. PTG was not related to urgent healthcare use.
  
  
  CONCLUSIONS
  Greater PTG was related to greater objective risk of morbidity but not actual morbidity, suggesting that contemplation about the risk of future health problems may spur PTG. Moreover, greater PTG was associated with seeking non-urgent healthcare. Whether this translates to improved health outcomes warrants future study.
authors.affiliation: York University, Canada. yvonnewleung@gmail.com
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Leung
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Peter L
authors.initials: PL
authors.lastname: Prior
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: Jane
authors.initials: J
authors.lastname: Irvine
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003324:Coronary Artery Disease / Q000517:prevention & control / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010553:Personality Development; D011446:Prospective Studies; D055502:Secondary Prevention; D012803:Sick Role; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*; D014600:Utilization Review