title: Post-traumatic stress disorder symptoms in first-time myocardial infarction patients: roles of attachment and alexithymia.
abstract: OBJECTIVE
  To explore the roles of attachment and alexithymia in the severity of post-traumatic stress disorder symptoms and to specify the relationship between sub-dimensions of attachment, alexithymia and posttraumatic stress disorder symptoms in patients with first-time myocardial infarction in mainland China.
  
  
  BACKGROUND
  Patients experiencing myocardial infarction have a risk of developing post-traumatic stress disorder symptoms. However, there have been few studies on the roles of attachment and alexithymia.
  
  
  METHODS
  A cross-sectional survey design.
  
  
  METHODS
  Ninety-seven patients participated in the assessment of post-traumatic stress disorder symptoms, attachment and alexithymia from June-December in 2012. To assess post-traumatic stress disorder symptoms and their correlates, we administered the Post-traumatic Stress Disorder Checklist-Civilian Version, the 20-item Toronto Alexithymia Scale and the Experiences in Close Relationships Scale 5-17 days after the remission of first myocardial infarction attack.
  
  
  RESULTS
  Twenty-five (25·77%) patients met the criteria of posttraumatic stress disorder symptoms. Greater attachment anxiety and avoidance were associated with more severe posttraumatic stress disorder symptoms. Except for externally oriented thinking, all dimensions of alexithymia were significantly correlated with post-traumatic stress symptoms. In the regression model, attachment anxiety and difficulties identifying feelings were found to be predictive and the total regression equation explained 24·2% variance of posttraumatic stress disorder symptoms among myocardial infarction patients.
  
  
  CONCLUSIONS
  First-time myocardial infarction patients were at risk of developing posttraumatic stress disorder symptoms. Attachment anxiety and difficulties identifying feelings were positively associated with posttraumatic stress disorder symptoms in the early stage of myocardial infarction rehabilitation. It is essential to evaluate the causal relationship between attachment, alexithymia and posttraumatic stress disorder symptoms in longitudinal studies.
authors.affiliation: School of Nursing, Shandong University, Jinan, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Gao
authors.affiliation: The Second Hospital of Shandong University, Jinan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: School of Nursing, Shandong University, Jinan, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: School of Nursing, Shandong University, Jinan, China.
authors.forename: Feng-Lin
authors.initials: FL
authors.lastname: Cao
mesh_terms: D000342:Affective Symptoms / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D009769:Object Attachment; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*
keywords: alexithymia; attachment; myocardial infarction; post-traumatic stress disorder symptoms