title: Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review.
abstract: BACKGROUND
  Acute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients' risk for subsequent cardiac events and mortality.
  
  
  OBJECTIVE
  To determine the prevalence of PTSD induced by ACS and to quantify the association between ACS-induced PTSD and adverse clinical outcomes using systematic review and meta-analysis.
  
  
  METHODS
  Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists.
  
  
  RESULTS
  Observational cohort studies that assessed PTSD with specific reference to an ACS event at least 1 month prior. We extracted estimates of the prevalence of ACS-induced PTSD and associations with clinical outcomes, as well as study characteristics. We identified 56 potentially relevant articles, 24 of which met our criteria (N = 2383). Meta-analysis yielded an aggregated prevalence estimate of 12% (95% confidence interval [CI], 9%-16%) for clinically significant symptoms of ACS-induced PTSD in a random effects model. Individual study prevalence estimates varied widely (0%-32%), with significant heterogeneity in estimates explained by the use of a screening instrument (prevalence estimate was 16% [95% CI, 13%-20%] in 16 studies) vs a clinical diagnostic interview (prevalence estimate was 4% [95% CI, 3%-5%] in 8 studies). The aggregated point estimate for the magnitude of the relationship between ACS-induced PTSD and clinical outcomes (ie, mortality and/or ACS recurrence) across the 3 studies that met our criteria (N = 609) suggested a doubling of risk (risk ratio, 2.00; 95% CI, 1.69-2.37) in ACS patients with clinically significant PTSD symptoms relative to patients without PTSD symptoms.
  
  
  CONCLUSIONS
  This meta-analysis suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Further tests of the association of ACS-induced PTSD and clinical outcomes are needed.
authors: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, United States of America. dee2109@columbia.edu
authors: Donald
authors: D
authors: Edmondson
authors: Safiya
authors: S
authors: Richardson
authors: Louise
authors: L
authors: Falzon
authors: Karina W
authors: KW
authors: Davidson
authors: Mary Alice
authors: MA
authors: Mills
authors: Yuval
authors: Y
authors: Neria
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality