Background: Clinician-rated large-scale studies estimating the prevalence of posttraumatic stress disorder (PTSD) related to myocardial infarction (MI) and identifying predictors of clinical PTSD are currently lacking. Hypotheses: We hypothesized that PTSD is prevalent in post-MI patients and that the subjective experience of the MI determines PTSD status. Methods: We approached 951 post-MI patients with a questionnaire screening for PTSD symptoms related to their MI. Those responding and meeting a cutoff of PTSD symptom levels were invited to participate in a structured clinical interview to diagnose PTSD following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Fear of dying, feelings of helplessness, and severity of pain perceived during the MI were also assessed by visual analog scales. Results: The screening questionnaire was completed by 394 patients, whereby 77 met the cutoff for the interview (8 patients declined the interview). Forty of 394 patients (10.2%) had clinical PTSD (subsyndromal and syndromal forms combined). Younger age (OR 0.95, 95% CI 0.91-0.99), greater fear of dying (OR 2.77, 95% CI 1.28-5.97), and more intense feelings of helplessness (OR 2.97, 95% CI 1.42-6.21) were independent predictors of PTSD status. Perceived pain intensity during MI, sex, type of index MI, left ventricular ejection fraction, number of coronary occlusions, and highest level of total creatinine kinase were not significant predictors. Conclusions: Clinical PTSD is prevalent in post-MI patients. Demographic and particularly psychological variables related to the subjective experience of the event were stronger predictors of PTSD status than were objective measures of MI severity.

OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/-12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level. PREVALENCE AND PREDICTORS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN ACUTE MYOCARDIAL INFARCTION PATIENTS Methods:We recruited 400 patients (mean age 60±12 years, 79% men) with a previous acute index MI referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale (CAPS) and self-rated severity of PTSD symptom levels by the Posttraumatic Diagnostic Scale (PDS). Results:Of the 190 patients who completed the PDS, 34 met the cut-off for clinically significant PTSD symptomatology and 32 agreed to be interviewed. In these, the CAPS interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% CI 7.4-11.6).Retrospectively rated feelings of helplessness (β=.47, p<.001) and pain intensity during MI (β=.15, p=.019) independently predicted PTSD symptom level.Conclusions: Almost 10% of post-MI patients had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.2

Elevated levels of PTSD symptoms caused by MI may adversely impact non-fatal cardiovascular outcome in post-MI patients independent of other important prognostic factors. The possible importance of PTSD symptoms as a novel prognostic psychosocial risk factor in post-MI patients warrants further study.