title: Dimensional structure and correlates of posttraumatic stress symptoms following suspected acute coronary syndrome.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas.
  
  
  METHODS
  We conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD.
  
  
  RESULTS
  Although all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication.
  
  
  CONCLUSIONS
  One limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease.
  
  
  CONCLUSIONS
  Findings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, 722W. 168th St, New York, NY 10032, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. Electronic address: js4456@cumc.columbia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622W. 168th St, New York, NY 10032, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.affiliation: Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622W. 168th St, New York, NY 10032, USA.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622W. 168th St, New York, NY 10032, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622W. 168th St, New York, NY 10032, USA.
authors.forename: Faith E
authors.initials: FE
authors.lastname: Parsons
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622W. 168th St, New York, NY 10032, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Acute coronary syndrome; Confirmatory factor analysis; Latent structure; Posttraumatic stress disorder