Development and validation of a risk prediction model for post-traumatic stress disorder symptoms in patients with acute myocardial infarction in China

Abstract

Background: At present, there are many influencing factors of post-traumatic stress disorder (PTSD) symptoms in patients with acute myocardial infarction (AMI), but based on this, there are few studies on the risk prediction model of PTSD symptoms. The aim of this study was to investigate the risk factors of PTSD symptoms in patients with AMI and to construct a risk prediction model. Methods: From April 2021 to March 2022, 287 patients were enrolled from a hospital in Shandong Province, China. According to the PTSD Checklist (PCL-C) scores 30 days after discharge, the participants were divided into a PTSD symptoms group (92 cases) and a non-PTSD symptoms group (195 cases). The demographic data, disease factors, treatment factors, and laboratory examination indicators were compared between the 2 groups; independent risk factors were screened out, and a risk prediction model was constructed by logistic regression. Area under the curve (AUC) was used as the internal verification of the model prediction. From April 2022 to June 2022, 72 patients with AMI in a hospital in Shandong Province were selected. PCL-C data were collected 30 days after discharge, and finally external validation of the model was performed. Results: Five factors, including gender [odds ratio (OR) =3.325], diabetes history (OR =2.292), creatine kinase isozyme (OR =1.046), insomnia score (OR =2.045), and fear of disease progression score (OR =1.126) were included to construct the risk prediction model. According to the Hosmer-Lemeshow test, P=0.785.The AUC was 0.910, the maximum value of Youden index was 0.751, the sensitivity was 0.870, the specificity was 0.881, and the accuracy rate of practical application was 67.64%. Conclusions:The risk prediction model of PTSD symptoms in patients with AMI established in this study is consistent and effective. It can provide a reference for clinical assessment of PTSD symptoms risk in patients with AMI.

Meta-analysis of risk factors for posttraumatic stress disorder in myocardial infarction

“…Twenty-six influencing factors such as age, gender, and neuroticism score were extracted. The 10 articles included www.md-journal.com 2 cohort studies, [7,8] 7 cross-sectional studies, [9][10][11][12][13][14][15] and 1 casecontrol study, [16] published between 2003 and 2022. Assessment tools of PTSD were different in each study, including 4 assessment tools.…”

“…The basic characteristics and methodological quality evaluation of the literature. Bielas [10] 2018 183 14 7.7 PDS 3 mo after myocardial infarction 1, 2, 3 Cross-sectional study 8 Cui [11] 2022 287 92 32.06 PCL-C 30 d after discharge 4, 5, 6, 7, 8 Cross-sectional study 8 Cao [12] 2021 113 23 20.4 PCL-C 3 mo after myocardial infarction 9 Cross-sectional study 9 Pedersen [7] 2003 227 33 -PDS 4-6 wks after myocardial infarction 10, 11, 12 Cohort study 7 Dinenberg [9] 2014 579 37 6.4 CDIS 5 y after myocardial infarction 13, 14, 15, 16…”

“…Pedersen [8] 2016 226 34 -PDS 4-6 wks after myocardial infarction 17, 18, 11 Cohort study 7 Gao [13] 2019 266 85 32.0 PCL-C 60 d after myocardial infarction 19, 11, 20 Cross-sectional study 9 Xiong [14] 2014 240 68 28.3 PCL-C More than 1 mo after myocardial infarction 4, 21, 22 Cross-sectional study 8 Liang [15] 2016 178 41 23.03 PCL-C More than 1 mo after myocardial infarction 19,23,24,11 Cross-sectional study 8…”

“…Although these studies come from the same region and use the same assessment tools, they all have different criteria for determining positive PTSD. For example, Cui's [11] study takes scale score > 38 as the criterion for determining positive PTSD, while Cao's [12] study takes scale score ≥ 44 as the criterion for determining positive PTSD. The difference of positive criteria for PTSD may be the source of the high heterogeneity between the Chinese subgroup and the PCL-C subgroup.…”

“…Neurotic people are more likely to react emotionally to negative environmental stimuli, and anxiety and tension are the characteristics of neurotic people. [23] When facing more serious physical diseases, such people are more likely to have strong anxiety, anxiety, and tension, and are prone to misperception, mistaking the disease as a "terminal disease" or a disease that is difficult to Neuroticism score [7,8,13,15] 4 98.2 <0.001 Random-effects model 2.069 (1.069,4.006) 0.031 0.907 1.000 Educational level [10,16] 2 83.4 0.014 Random effect model 0.547 (1.069,4.484) 0.574 -1.000 Sex [11,14] 2 0.0 0.842 Fixed effect model 3.124 (1.966,4.965) <0.001 -1.000 Killip grading [14,16] 2 87.1 0.005 Random effect model 2.292 (0.906,5.798) 0.08 -1.000 Age [13,15] 2 0.0 0.602 Fixed effect model 0.913 (0.866,0.961) 0.001 -1.000 OR = odd ratio cure, mistaking the residual discomfort and discomfort and other physical and mental changes common in normal patients after treatment as pathological or obvious abnormalities, and attempting to remove these physical and mental changes. The more you try to remove it, the worse the symptoms become, creating a vicious cycle that eventually leads to PTSD.…”