Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events

Meli, Laura; Alcántara, Carmela; Sumner, Jennifer A.; Swan, Brendan; Edmondson, Donald

doi:10.1177/1359105317705982

Cited by 34 publications

(29 citation statements)

References 47 publications

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“…Traditional PTSD screening instruments or clinical interviews, such as the PDS and CAPS used in our study, are keyed to a single medical event in the past (i.e., the diagnosis and acute care/intervention for ACS), but they do not capture present and future-oriented re-experiencing symptoms of PTSD due to enduring threats of recurrence and functional decline in the wake of ACS; likewise avoidance and hyperarousal symptoms may also present in a different manner and with different psychological consequences [37]. A recent study confirmed the clinical importance of enduring somatic threat for PTSS in patients with ACS showing that a high level of acute distress at hospital admission was only predictive of ACS-induced PTSS 1 month later in those patients who also perceived ongoing cardiac threat in the form of anxious thoughts and feelings about cardiac symptoms [38]. A research agenda has been proposed to develop a taxonomy to recategorize the gamut of distressing psychological symptoms prevalent in survivors of a medical disease beyond the levels of PTSD and other psychiatric disorders [35].…”

Section: Discussionmentioning

confidence: 76%

Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial

Känel¹,

Barth

Princip

et al. 2018

Psychother Psychosom

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Background: Acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) and clinically significant PTSD symptoms (PTSS) are found in 4 and 12% of patients, respectively. We hypothesized that trauma-focused counseling prevents the incidence of ACS-induced PTSS. Methods: Within 48 h of hospital admission, 190 patients with high distress during ACS were randomized to a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 3 months of follow-up. Trial results about prevalence were compared with data from previous studies on the natural incidence of ACS-induced PTSS/PTSD. Results: Intention-to-treat analyses revealed no difference in interviewer-rated PTSS between trauma-focused counseling (mean, 11.33; 95% Cl, 9.23-13.43) and stress counseling (9.88; 7.36-12.40; p = 0.40), depressive symptoms (6.01, 4.98-7.03, vs. 4.71, 3.65-5.77; p = 0.08), global psychological distress (5.15, 4.07-6.23, vs. 3.80, 2.60-5.00; p = 0.11), and the risk for cardiovascular-related hospitalization/all-cause mortality (OR, 0.67; 95% CI, 0.37-1.23). Self-rated PTSS indicated less beneficial effects with trauma-focused (6.54; 4.95-8.14) versus stress counseling (3.74; 2.39-5.08; p = 0.017). The completer analysis (154 cases) confirmed these findings. The prevalence rates of interviewer-rated PTSD (0.5%, 1/190) and self-rated PTSS were in this trial much lower than in meta-analyses and observation studies from the same cardiology department. Conclusions: Benefits were not seen for trauma-focused counseling when compared with an active control intervention. Nonetheless, in distressed ACS patients, individual, single-session, early psychological counseling shows potential as a means to prevent posttraumatic responses, but trauma-focused early treatments should probably be avoided.

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Section: Discussionmentioning

confidence: 76%

Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial

Känel¹,

Barth

Princip

et al. 2018

Psychother Psychosom

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“…26,27 It may be possible that the development of anxiety or "post-traumatic" stress response described in patients after life threatening events like ACS may also affect predisposed individuals after cardiac evaluation. 28 In any case, there is strong evidence showing that low risk or non-cardiac chest pain associated with anxiety and other psychological comorbidities are associated with more frequent medical visits than community norms. 25,29 It appears that normal test results and reassurance are not enough to allay the residual anxiety and persistent belief in a cardiac cause of their chest pain symptoms.…”

Section: Accepted Manuscript 11mentioning

confidence: 99%

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Musey

Patel

Fry

et al. 2018

The American Journal of Cardiology

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Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits.

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“…Further research is required to test whether the association between perceived threat in the ED and PTSD symptoms at 30 days among patients with nontraumatic medical emergencies is mediated by peritraumatic dissociation. In addition, prior research in patients with acute coronary syndrome suggests that perceived threat in the ED predicts PTSD symptoms at 30 days primarily in patients who continue to report ongoing body‐focused worry in the month after discharge, so future research should assess enduring somatic threat perceptions in these patients …”

Section: Discussionmentioning

confidence: 99%

“…In addition, prior research in patients with acute coronary syndrome suggests that perceived threat in the ED predicts PTSD symptoms at 30 days primarily in patients who continue to report ongoing body-focused worry in the month after discharge, so future research should assess enduring somatic threat perceptions in these patients. 37 There are currently large ongoing studies evaluating PTSD among traumatic injury survivors (AURORA study, https://www.med.unc.edu/itr/aurora-study) as well as patients with acute stroke, acute coronary syndrome, and post-cardiac arrest syndrome (REactions to Acute Care and Hospitalization [REACH] study, NCT03605693). 27 Our results expand upon the REACH study as it identifies an additional cohort of subjects who are also at risk for a high degree of perceived threat in the ED and the subsequent development of PTSD symptoms.…”

Section: Discussionmentioning

confidence: 99%

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

Moss

Roberts

Shea

et al. 2019

Academic Emergency Medicine

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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.

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Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events

Cited by 34 publications

References 47 publications

Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial

Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

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

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