title: Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: A case-control study.
abstract: BACKGROUND
  The role of psychological factors in the onset of takotsubo cardiomyopathy (TC) is still controversial. Associations with previous psychiatric conditions are registry-based; associations with personality characteristics and psychological sequelae of TC have been largely unexplored. This case-control study sought to study pre-admission psychiatric morbidity, personality traits, and post-discharge distress in incident cases of TC.
  
  
  METHODS
  TC cases (Mayo clinic criteria) and acute myocardial infarction (MI) controls were recruited among women admitted to two Emergency Departments in New England. Healthy controls (HC) were recruited from a volunteers' registry. Preadmission psychiatric history (DSM-IV-TR) was abstracted from the medical record. PTSD symptoms (Impact of Events Scale); distress (Hospital Anxiety and Depression Scale); perceived stress (PS scale) and personality traits (optimism; hostility, type D personality) were collected via phone interview one month after discharge.
  
  
  RESULTS
  From March 2013 through October 2015, 107 participants (45 TC, 32 MI and 30 HC) were enrolled. The prevalence of preadmission anxiety disorders was 24.4% in TC, 9.4% in MI, and 0 in HC (p = 0.007) while that of mood disorders was similar across groups. TC had higher psychological distress, perceived stress, and PTSD symptoms post-discharge vs. MI and HC. In adjusted models, PTSD symptoms remained higher in TC vs. MI (b = 0.55, p < 0.05) and vs. HC (b = 0.92, p < 0.01). Optimism and hostility scores were similar across groups, while type D (social inhibition) scores were higher in TC and MI vs. HC.
  
  
  CONCLUSIONS
  Preadmission anxiety, but not depression, was associated with the occurrence of TC. High distress and PTSD symptoms post-discharge indicate that TC women may be at risk for poor psychological adjustment.
authors.affiliation: Department of Medicine, Brown University Medical School, United States; The Miriam Hospital, United States. Electronic address: Elena_Salmoirago-Blotcher@brown.edu.
authors.forename: Elena
authors.initials: E
authors.lastname: Salmoirago-Blotcher
authors.affiliation: Department of Psychology, East Carolina University, United States.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Rosman
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, United States.
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Wittstein
authors.affiliation: The Miriam Hospital, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, United States.
authors.forename: Shira
authors.initials: S
authors.lastname: Dunsiger
authors.affiliation: Department of Medicine, Hartford Hospital, United States.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Swales
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, United States.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, United States.
authors.forename: Ira S
authors.initials: IS
authors.lastname: Ockene
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009511:New England / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends; D010551:Personality; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000523:psychology*
keywords: Anxiety; Cardiomyopathy; Depression; Heart failure; Stress