title: Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients.
abstract: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.
  
  
  
  Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.
  
  
  
  PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.
  
  
  
  The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.
  
  
  
  In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: L.Kok-3@umcutrecht.nl.
authors.forename: Lotte
authors.initials: L
authors.lastname: Kok
authors.affiliation: Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Milou S
authors.initials: MS
authors.lastname: Sep
authors.affiliation: Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
authors.forename: Dieuwke S
authors.initials: DS
authors.lastname: Veldhuijzen
authors.affiliation: Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Cornelisse
authors.affiliation: Department of Anesthesiology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van der Maaten
authors.affiliation: Department of Anesthesiology, Amphia Hospital, Breda, The Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rosseel
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.affiliation: Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.affiliation: Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Christiaan H
authors.initials: CH
authors.lastname: Vinkers
authors.affiliation: Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Joëls
authors.affiliation: Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
authors.affiliation: Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Manon H
authors.initials: MH
authors.lastname: Hillegers
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality; D010555:Personality Inventory; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D019616:Thoracic Surgical Procedures / Q000523:psychology*
keywords: Cardiac surgery; Childhood trauma; Depression; Intensive care unit; Post-traumatic stress disorder; Trait anxiety