Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies

Abstract

Background Our objectives were to test whether during a potentially life‐threatening medical emergency, perceived threat (a patient’s sense of life endangerment) in the emergency department (ED) is common and associated with the subsequent development of posttraumatic stress disorder (PTSD) symptoms. Methods This study was an ED‐based prospective cohort study in an academic hospital. We included adult patients requiring acute intervention in the ED for resuscitation of a potentially life‐threatening medical emergency, defined as respiratory or cardiovascular instability. We measured patient‐perceived threat in the ED using a validated patient self‐assessment measure (score range = 0 to 21, with higher scores indicating greater perceived threat). We performed blinded assessment of PTSD symptoms 30 days after discharge using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders‐Fifth Edition (PCL‐5). Results Ninety‐nine of 113 (88%) patients completed follow‐up, with 98% reporting some degree of perceived threat, median (interquartile range [IQR]) perceived threat score 12 (6 to 17), and 72% reported PTSD symptoms in relation to their ED visit (median [IQR] PCL‐5 score = 7 [0 to 30]). Patients with respiratory instability had higher median (IQR) perceived threat scores (16 [9 to 18] vs. 9 [6 to 14)] and PCL‐5 scores (10 [2 to 40] vs. 3 [0 to 17]) compared to patients without respiratory instability. In a multivariable linear regression model adjusting for potential confounders, greater perceived threat in the ED was independently associated with higher PCL‐5 scores (β = 0.79, 95% confidence interval [CI] = 0.15 to 1.42). Among the individual perceived threat items, the feeling of helplessness during resuscitation had the strongest association with PCL‐5 score (β = 5.24, 95% CI = 2.29 to 8.18). Conclusions Perceived threat during potentially life‐threatening emergencies is common and independently associated with development of PTSD symptoms. Additional research to test whether reduction of perceived threat in the ED attenuates the development of PTSD symptoms following potentially life‐threatening emergencies is warranted.

Are There Long‐term Consequences to Psychological Stress During a Medical Event?

“…Several active federally funded prospective studies are currently under way examining the development of psychological and somatic symptoms in ED survivors of acute events from trauma (U01 MH110925: AURORA), ischemic stroke (HL 141811), and cardiac events (HL 132347). Data from these projects and others will complement the work presented by Moss et al 1 and build on our understanding of psychological recovery following acute medical events.…”

“…In their primary analysis, Moss et al 1 found that there was no significant association with environmental factors, such as ED crowding and subsequent PTSD symptom severity. Other studies, with larger samples, have found a correlation between environmental factors such as ED crowding and PTSD severity, using different operationalizations of crowding, such as the EDWIN score.…”

“…Understanding the impact of psychological stress during medical events is important, not only for our understanding of the potential development of short‐ and long‐term adverse psychological outcomes but also for its implications with broader health and recovery. In their recent study, Moss et al assessed patient perceived fear (e.g., “threat”) during evaluation of a life‐threatening cardiovascular or respiratory event. In this sample of 99 patients, they found that almost all (98%) patients who completed the assessment reported some degree of perceived threat on a validated screening measure, while 72% of individuals reported posttraumatic symptoms in relation to their ED visit at follow‐up.…”

“…Understanding the psychological reactions experienced by patients during such events provides another layer of information regarding the acute experience of patients treated in the ED. The work by Moss et al is an important contribution to our understanding of the sustained effects that psychological stress during acute medical events may have on long‐term patient well‐being. Work building on this study will improve our understanding of these effects and ideally lead to the identification of modifiable targets of interventions to improve patient recovery in the near‐ and long‐term setting.…”

Life threat during assaultive trauma: Critical posttraumatic stress disorder risk factors for injured patients

“…Similarly, patients experiencing medical emergencies in an emergency department (ED) had greater risk of PTSD development if they perceived their life was endangered at the time. 24 Collectively, this evidence suggests that a patient's acute experience and perception of the event are key to assess when considering long-term risk of PTSD within trauma-injured populations.…”