title: Post-traumatic stress symptoms and exacerbations in COPD patients.
abstract: BACKGROUND
  Post-Traumatic Stress Disorder (PTSD) is a common psychological consequence of exposure to traumatic stressful life events. During COPD exacerbations dyspnea can be considered a near-death experience that may induce post-traumatic stress symptoms. The aim of this study was to evaluate the relationship between COPD exacerbations and PTSD- related symptoms.
  
  
  METHODS
  Thirty-three in-patients with COPD exacerbations were screened for the following: PTSS (Screen for Posttraumatic Stress Symptoms), anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory). Patients had a median age of 72 years and 72.7% were female.
  
  
  RESULTS
  Mean FEV1 and FVC were 0.8 ± 0.3 (37.7 ± 14.9% of predicted) and 1.7 ± 0.6 (60 ± 18.8% of predicted), respectively with a mean exacerbation of 2.9 episodes over the past year. Post-traumatic stress symptoms related to PTSD were found in 11 (33.3%) patients (SPTSS mean score 4.13 ± 2.54); moderate to severe depression in 16 (48.5%) (BDI mean score 21.2 ± 12.1) and moderate to severe anxiety in 23 (69.7%) (BAI mean score 23.5 ± 12.4). In a linear regression model, exacerbations significantly predicted post-traumatic stress symptoms scores: SPTSS scores increased 0.9 points with each exacerbation (p = 0.001). Significant correlations were detected between PTSD-related symptoms and anxiety (rs = 0.57; p = 0.001) and PTSD symptoms and depression (rs = 0.62; p = 0.0001). In a multivariable analysis model, two or more exacerbation episodes led to a near twofold increase in the prevalence ratio of post-traumatic stress symptoms related to PTSD(PR1.71; p = 0.015) specially those requiring hospitalization (PR 1.13; p = 0.030) CONCLUSION: PTSD symptoms increase as the patient's exacerbations increase. Two or more exacerbation episodes lead to a near twofold increase in the prevalence ratio of post-traumatic symptomatology. Overall, these findings suggest that psychological domains should be addressed along with respiratory function and exacerbations in COPD patients.
authors.affiliation: sup>1Pavilh"o Pereira Filho, Santa Casa de Porto Alegre, Federal University of Health Sciences of Porto Alegre , Brazil.
authors.forename: Paulo Josè Zimermann
authors.initials: PJ
authors.lastname: Teixeira
authors.forename: Lucia
authors.initials: L
authors.lastname: Porto
authors.forename: Christian Haag
authors.initials: CH
authors.lastname: Kristensen
authors.forename: Alvaro Huber
authors.initials: AH
authors.lastname: Santos
authors.forename: Sergio Saldanha
authors.initials: SS
authors.lastname: Menna-Barreto
authors.forename: Pedro AntÙnio Schmidt
authors.initials: PA
authors.lastname: Do Prado-Lima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology*
keywords: COPD; airflow limitation; exacerbations; post-traumatic stress disorder; psychological aspects