title: Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications.
  
  
  METHODS
  We surveyed 535 participants, age ≥40 years old, who had at least 1 stroke or TIA in the previous 5 years. PTSD was assessed using the PTSD Checklist-Specific for stroke; a score ≥50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression.
  
  
  RESULTS
  Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke ≥50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%, P<0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7-4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke <25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence.
  
  
  CONCLUSIONS
  PTSD is common after stroke/TIA. Patients who have PTSD after stroke or TIA are at increased risk for medication nonadherence.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA. ik2293@columbia.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.forename: Judith Z
authors.initials: JZ
authors.lastname: Goldfinger
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.forename: Carol R
authors.initials: CR
authors.lastname: Horowitz
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology; D020521:Stroke / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome; D016903:Drug Monitoring