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Princip M, Ledermann K, Altwegg R, von Känel R. Cardiac disease-induced trauma and stress-related disorders. Herz 2024; 49:254-260. [PMID: 38990256 DOI: 10.1007/s00059-024-05255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. BACKGROUND Experiencing a cardiovascular disease, particularly a life-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with a worsening cardiac prognosis and higher mortality rates. Approaching treatment through a trauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. CONCLUSION Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.
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MESH Headings
- Humans
- Stress Disorders, Post-Traumatic/therapy
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/diagnosis
- Heart Diseases/etiology
- Heart Diseases/therapy
- Risk Factors
- Adjustment Disorders/diagnosis
- Adjustment Disorders/therapy
- Adjustment Disorders/etiology
- Adjustment Disorders/psychology
- Prevalence
- Comorbidity
- Stress Disorders, Traumatic, Acute/therapy
- Stress Disorders, Traumatic, Acute/diagnosis
- Stress Disorders, Traumatic, Acute/etiology
- Stress Disorders, Traumatic, Acute/psychology
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Rahel Altwegg
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
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Friberg K, Hofsø K, Rustøen T, Ræder J, Hagen M, Puntillo K, Olsen BF. Patient characteristics associated with posttraumatic stress symptoms in intensive care unit survivors during a one-year follow-up: A multicenter study. Heart Lung 2024; 66:1-8. [PMID: 38492243 DOI: 10.1016/j.hrtlng.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. OBJECTIVES To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. METHODS Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. RESULTS High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. CONCLUSIONS The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these.
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Affiliation(s)
- Klara Friberg
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University Collage, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo University Hospital, Department of Postoperative and Critical Care Nursing, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Tone Rustøen
- University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Johan Ræder
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Postbox 0316 Oslo, Norway
| | - Milada Hagen
- Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Public Health, Faculty of Health Sciences, Postbox 4, St Olavs plass, 0130 Oslo, Norway
| | - Kathleen Puntillo
- University of California, Department of Physiological Nursing, School of Nursing, 2 Koret Way, San Francisco, 94143 California, USA
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; Østfold University College, Faculty of Health and Welfare, Postbox 700, 1757 Halden, Norway
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Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
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Lopez-Veneros D, Cumella R, Kronish IM, Lazarov A, Birk JL. Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial. Pilot Feasibility Stud 2024; 10:7. [PMID: 38212853 PMCID: PMC10782680 DOI: 10.1186/s40814-024-01442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS. METHODS We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time). RESULTS Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete. CONCLUSION Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability. TRIAL REGISTRATION Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .
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Affiliation(s)
- David Lopez-Veneros
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Robin Cumella
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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Birk JL, Cornelius T, Kronish IM, Shechter A, Diaz KM, Schwartz JE, Garcia OG, Cruz GJ, Shaw K, Sanchez GJ, Agarwal S, Edmondson D. Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study. Gen Hosp Psychiatry 2024; 86:103-107. [PMID: 38181710 PMCID: PMC10872378 DOI: 10.1016/j.genhosppsych.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization. METHOD In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device. RESULTS Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients. CONCLUSIONS Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA.
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Othanya G Garcia
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gaspar J Cruz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Kaitlin Shaw
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA; Psychology Department, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY 8GS-300, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
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Khan N, Iqra Tanveer Khan S, Joti S, Malik J, Faraz M, Ashraf A. Association of Cardiovascular Diseases With Post-Traumatic Stress Disorder: An Updated Review. Cardiol Rev 2023:00045415-990000000-00174. [PMID: 37966219 DOI: 10.1097/crd.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The intricate relationship between post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD) has garnered increasing attention due to its bidirectional impact and potential for significant health consequences. Epidemiological evidence suggests that PTSD may serve as a risk factor for incident CVD, while acute CVD events can trigger PTSD, subsequently increasing the risk of recurrent cardiovascular events. This dynamic interplay is characterized by the human stress response, disrupted behavioral and lifestyle factors, and potential physiological mechanisms. Notably, the immediate aftermath of a cardiovascular event presents a critical window for intervention, offering the possibility of preventing the development of PTSD and its associated physiological and behavioral sequelae. However, while candidate mechanisms linking PTSD and CVD have been identified, determining which mechanisms are most amenable to intervention remains a challenge. This article emphasizes the urgency of addressing key unanswered questions in this domain. Despite an evolving understanding of the association between PTSD and CVD, causal relationships remain to be firmly established. Comprehensive investigations into the intricate interplay of behavioral and biological mechanisms are essential for identifying precise targets for intervention. Innovations in research methodologies, including the exploration of PTSD symptom dynamics and their impact on cardiovascular function, hold the potential for identifying crucial intervention points. Drawing parallels from prior challenges in translating identified risk factors into effective interventions, the field must prioritize systematic investigations and early-phase intervention trials. By doing so, researchers and clinicians can potentially develop strategies to mitigate CVD risk in the context of PTSD and improve both cardiovascular and mental health outcomes.
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Affiliation(s)
- Naqeeb Khan
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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Jiang X, Zhang C, Pan Y, Cheng X, Zhang W. Effects of C-reactive protein trajectories of critically ill patients with sepsis on in-hospital mortality rate. Sci Rep 2023; 13:15223. [PMID: 37709919 PMCID: PMC10502021 DOI: 10.1038/s41598-023-42352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
Sepsis, a life-threatening condition caused by an inflammatory response to systemic infection, results in a significant social burden and healthcare costs. This study aimed to investigate the relationship between the C-reactive protein (CRP) trajectories of patients with sepsis in the intensive care unit (ICU) and the in-hospital mortality rate. We reviewed 1464 patients with sepsis treated in the ICU of Dongyang People's Hospital from 2010 to 2020 and used latent growth mixture modeling to divide the patients into four classes according to CRP trajectory (intermediate, gradually increasing, persistently high, and persistently low CRP levels). We found that patients with intermediate and persistently high CRP levels had the lowest (18.1%) and highest (32.6%) in-hospital mortality rates, respectively. Multiple logistic regression analysis showed that patients with persistently high (odds ratio [OR] = 2.19, 95% confidence interval [CI] = 1.55-3.11) and persistently low (OR = 1.41, 95% CI = 1.03-1.94) CRP levels had a higher risk of in-hospital mortality than patients with intermediate CRP levels. In conclusion, in-hospital mortality rates among patients with sepsis differ according to the CRP trajectory, with patients with intermediate CRP levels having the lowest mortality rate. Further research on the underlying mechanisms is warranted.
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Affiliation(s)
- Xuandong Jiang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China.
| | - Chenlu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Yuting Pan
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
| | - Xuping Cheng
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
| | - Weimin Zhang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Malinauskas R, Malinauskas M, Malinauskiene V, Zabiela V. Perceived Stress in Relation to Demographics and Clinical Forms among Patients with Infective Endocarditis: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14073. [PMID: 36360948 PMCID: PMC9656878 DOI: 10.3390/ijerph192114073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Infective endocarditis (IE) is a disease of the endocardial surface of the heart, caused by infection of the native or prosthetic valve or an indwelling cardiac device. Apart from IE predisposing risk factors that include heart conditions and medical procedures, the novel trajectories from demographic factors to perceived stress conditions have been under investigation in recent years. The aim of the present study was to evaluate the associations between perceived stress and demographic characteristics as well as clinical forms of IE among survivors of IE in Kaunas, Lithuania. (2) Methods: A cross-sectional study among IE cases (n = 135) at the Lithuanian University of Health Sciences Kaunas Clinics Cardiology department during the period 2014-2017 was performed. Data about IE clinical features, sociodemographic characteristics and perceived stress level (Perceived Stress Scale (PSS-10)) upon diagnosis were collected. Package "SPSS 25.0" was used in the statistical analysis. Logistic regression analysis was performed including gender, previous occupation, place of residence and clinical forms of IE in the analysis of perceived stress among survivors of IE. The STROBE checklist for cross-sectional studies was used in this study. (3) Results: Perceived stress was experienced by 54.8 percent of the respondents. In the final model, the OR (odds ratio) of perceived stress for females was 2.07 as compared to men; for rural residents, the OR was 2.25 as compared to urban residents. These results were statistically significant. A tendency for increased OR of perceived stress for low-skilled workers as compared to high-skilled ones and classical IE clinical form as compared to non-classical form was observed, but these results were not statistically significant. (4) Conclusions: The present study is an attempt to focus the attention of IE researchers on the effects of psychological state in the disease development. Differences in perceived stress and some demographic characteristics, as well as tendencies of IE clinical forms, were observed among survivors of IE in Kaunas, Lithuania.
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Affiliation(s)
- Romualdas Malinauskas
- Department of Physical and Social Education, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania
| | - Mindaugas Malinauskas
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu Street 2, LT-50161 Kaunas, Lithuania
| | - Vilija Malinauskiene
- Department of Physical and Social Education, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu Street 2, LT-50161 Kaunas, Lithuania
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11
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Onukwuli V, Aronu A, Chinawa A, Ossai E, Chinawa J, Odinka P, Odinka J. Posttraumatic Stress Disorder among Secondary School Students during the COVID-19 Lockdown in Enugu. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_163_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Love MF, Wood GL, Wardell DW, Beauchamp JES. Resilience and associated psychological, social/cultural, behavioural, and biological factors in patients with cardiovascular disease: a systematic review. Eur J Cardiovasc Nurs 2021; 20:604-617. [PMID: 34223625 DOI: 10.1093/eurjcn/zvaa008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/27/2020] [Indexed: 01/25/2023]
Abstract
AIMS The aim of this systematic review of the literature is to synthesize the evidence regarding the associations between individual-level psychological, social/cultural, behavioral, and biological variables with resilience in patients with CVD. METHODS AND RESULTS A systematic search of PubMed, PsycINFO and CINAHL was conducted from database inception through March 2020. Studies with a quantitative research design were eligible for inclusion if published in English and focused on resilience among adults with CVD. Of the 788 articles retrieved, 34 studies (35 articles) were included in the review. Twenty-three studies focused on psychological factors, with findings of inverse relationships between resilience and depression, anxiety, and stress. Evidence regarding associations between resilience and social/cultural or behavioral variables was scarce. Four of the 6 studies regarding biological factors found low stress resilience in young adulthood was associated with early diagnoses of stroke, heart failure, and coronary heart disease. CONCLUSION Enhancing resilience may improve quality of life for CVD patients, but research is needed to further explore the complex relationships between resilience and associated variables. This research should prioritize under-represented groups (i.e. women and minority racial/ethnic groups), with the eventual goal of developing interventions to support resilience in CVD patients.
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Affiliation(s)
- Mary F Love
- University of Houston, College of Nursing, 14004 University Boulevard, Sugar Land, TX 77479, USA
| | - Geri LoBiondo Wood
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
| | - Diane Wind Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
| | - Jennifer E S Beauchamp
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
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13
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Alamri HS, Mousa WF, Algarni A, Megahid SF, Al Bshabshe A, Alshehri NN, Alsamghan A, Alsabaani A, Mirdad RT, Alshahrani AM, Gadah AA, Alshehri AA. COVID-19 Psychological Impact on Health Care Workers in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6076. [PMID: 34199953 PMCID: PMC8200187 DOI: 10.3390/ijerph18116076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Little is known about the impact of Coronavirus (COVID-19) among the health care workers in Saudi Arabia. Therefore, the present study aimed to assess the psychological impact of COVID-19 among the health care workers. METHODS A cross-sectional survey was conducted from May till mid-July among 389 health care workers from government and private hospitals in Saudi Arabia. Data was collected using a pre-structured online questionnaire that measured adverse psychological outcomes, including the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The Pearson chi-square test was used to assess the distribution of depression and anxiety among health care workers. RESULTS A high level of anxiety was recorded among the health care workers, and 69.3% of health care workers below the age of 40 were found to have depression. There was a significant increase in depression among staff with chronic health problems (72.1% vs. 61.9%; p = 0.048). High anxiety levels were detected among young staff compared to others (68.7% vs. 43.8%; p = 0.001). Moreover, 82.1% of the female staff were anxious, as compared to 55.6% of the males (p = 0.001). CONCLUSIONS We found increased prevalence of adverse psychological outcomes among the health care workers in Saudi Arabia during the outbreak of COVID-19. Therefore, there is a need for proper screening and development of corresponding preventive measures to decrease the adverse psychological outcomes.
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Affiliation(s)
- Hasan S. Alamri
- Department of Medicine, College of Medicine, King Khalid University, Abha 62527, Saudi Arabia; (A.A.B.); (N.N.A.)
| | - Wesam F. Mousa
- College of Medicine, University of Tanta, Tanta 31512, Egypt;
| | | | - Shehata F. Megahid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.F.M.); (A.A.); (A.A.)
- Biostatistics Department, High Institute of Public Health, Alexandria University, 65 Garidet St., El Horeya Rd., El Shatby, Alexandria 21526, Egypt
| | - Ali Al Bshabshe
- Department of Medicine, College of Medicine, King Khalid University, Abha 62527, Saudi Arabia; (A.A.B.); (N.N.A.)
| | - Nada N. Alshehri
- Department of Medicine, College of Medicine, King Khalid University, Abha 62527, Saudi Arabia; (A.A.B.); (N.N.A.)
| | - Awad Alsamghan
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.F.M.); (A.A.); (A.A.)
| | - Abdullah Alsabaani
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.F.M.); (A.A.); (A.A.)
| | - Rasha T. Mirdad
- Armed Forces Hospital Southern Region, Khamis Mushait 62413, Saudi Arabia;
| | | | - Alya A. Gadah
- King Abdulaziz Medical City, Riyadh 14611, Saudi Arabia;
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14
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Tarsitani L, Vassalini P, Koukopoulos A, Borrazzo C, Alessi F, Di Nicolantonio C, Serra R, Alessandri F, Ceccarelli G, Mastroianni CM, d’Ettorre G. Post-traumatic Stress Disorder Among COVID-19 Survivors at 3-Month Follow-up After Hospital Discharge. J Gen Intern Med 2021; 36:1702-1707. [PMID: 33782888 PMCID: PMC8007055 DOI: 10.1007/s11606-021-06731-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a severe but treatable mental disorder that develops after a life-threatening traumatic event. Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the severe acute respiratory syndrome coronavirus 2 pandemic, with daily media bombardment about COVID-19 mortality, may have amplified life-threatening perception also in patients with moderate infection. The aim of this study was to assess the prevalence and risk factors of PTSD at 3-month follow-up in patients hospitalised for COVID-19 infection. DESIGN In this cohort follow-up study conducted in a large Italian academic COVID-19 hospital, 115 recruited survivors were contacted by telephone 3 months after discharge to home care. The Posttraumatic Stress Disorder Checklist for DSM-5 was administered. Multivariate logistic regression models were used to analyse risk factors for the development of PTSD. KEY RESULTS A total of 10.4% of the sample received a PCL-5-based diagnosis of PTSD. Other 8.6% of the sample received a diagnosis of subthreshold PTSD, which leads to significant levels of distress and impairment. Multivariate regression analysis indicated that previous psychiatric diagnosis (odds ratio (OR) = 6.3, 95% confidence interval (CI): 3.7-78.6, p < 0.001) and obesity (OR = 3.51, 95% CI: 1.4-857.9, p = 0.03) were risk factors for developing PTSD. Chronic pulmonary diseases approached significance as a risk factor (OR = 6.03, 95% CI: 1.0-37.1, p = 0.053). Male sex was a protective factor (OR=0.04, 95% CI: 0.0-0.041, p = 0.007). CONCLUSIONS PTSD and subthreshold PTSD rates in patients hospitalised for COVID-19 are worrying. Female sex and pre-existing mental disorders are established risk factors for PTSD, while the prospective association with obesity needs further investigation. Clinicians treating COVID-19 should consider screening for PTSD at follow-up assessments in patients discharged from the hospital.
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Affiliation(s)
- Lorenzo Tarsitani
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Paolo Vassalini
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Alexia Koukopoulos
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Federica Alessi
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Chiara Di Nicolantonio
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Riccardo Serra
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Francesco Alessandri
- Intensive Care Unit, Department of General and Specialist Surgery “Paride Stefanini”, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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15
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Understanding trajectories of underlying dimensions of posttraumatic psychopathology. J Affect Disord 2021; 284:75-84. [PMID: 33588239 PMCID: PMC7927420 DOI: 10.1016/j.jad.2021.01.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research suggests four modal trajectories of psychological symptoms after traumatic injury: Resilient, Chronic, Delayed Onset, Recovery. However, most studies focus on symptoms of psychiatric disorders (e.g., posttraumatic stress disorder, depression), which are limited by heterogeneity and symptom overlap. We examined trajectories of cross-cutting posttraumatic symptom dimensions following traumatic injury and predictors of trajectory membership. METHODS In this longitudinal study of 427 predominantly Hispanic/Latino traumatic injury survivors, posttraumatic psychopathology symptoms were assessed during hospitalization and approximately one and five months post-trauma. Using latent class growth analysis, we estimated trajectories of several posttraumatic symptom dimensions: re-experiencing, avoidance, anxious arousal, numbing, dysphoric arousal, loss, and threat. We then examined sociodemographic and trauma-related characteristics (measured during hospitalization) as predictors of trajectory membership for each dimension. RESULTS Four trajectories (Resilient, Chronic, Delayed Onset, Recovery) emerged for all dimensions except loss and threat, which manifested three trajectories (Resilient, Chronic, Delayed Onset). Across dimensions, membership in the Chronic (vs. Resilient) trajectory was consistently predicted by unemployment (7 of 7 dimensions), followed by older age (3/7), female sex (3/7), and assaultive trauma (2/7). For several dimensions, unemployment also distinguished between participants who presented with similar symptom levels days after trauma, but then diverged over time. LIMITATIONS Measures of posttraumatic symptom dimension constructs differed across assessments. CONCLUSIONS This study provides evidence of distinct trajectories across transdiagnostic symptom dimensions after traumatic injury. Employment status emerged as the most important predictor of trajectory membership. Research is needed to better understand the etiologies and consequences of these posttraumatic symptom dimension trajectories.
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16
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von Känel R, Meister-Langraf RE, Barth J, Schnyder U, Pazhenkottil AP, Ledermann K, Schmid JP, Znoj H, Herbert C, Princip M. Course, Moderators, and Predictors of Acute Coronary Syndrome-Induced Post-traumatic Stress: A Secondary Analysis From the Myocardial Infarction-Stress Prevention Intervention Randomized Controlled Trial. Front Psychiatry 2021; 12:621284. [PMID: 34108894 PMCID: PMC8183467 DOI: 10.3389/fpsyt.2021.621284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/12/2021] [Indexed: 01/14/2023] Open
Abstract
Acute coronary syndromes (ACS) induce post-traumatic stress symptoms (PTSS) in one out of eight patients. Effects of preventive interventions, the course and potential moderators of ACS-induced PTSS are vastly understudied. This study explored whether a preventive behavioral intervention leads to a decrease in myocardial infarction (MI)-induced PTSS between two follow-up assessments. Sociodemographic, clinical and psychological factors were additionally tested as both moderators of change over time in PTSS and predictors of PTSS across two follow-ups. Within 48 h after reaching stable circulatory conditions, 104 patients with MI were randomized to a 45-min one-session intervention of either trauma-focused counseling or stress counseling (active control). Sociodemographic, clinical, and psychological data were collected at baseline, and PTSS were assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale 3 and 12 months post-MI. PTSS severity showed no change over time from 3 to 12 months post-MI, either in all patients or through the intervention [mean group difference for total PTSS = 1.6 (95% CI -1.8, 4.9), re-experiencing symptoms = 0.8 (95% CI -0.7, 2.2), avoidance/numbing symptoms = 0.1 (95% CI -1.6, 1.7) and hyperarousal symptoms = 0.6 (95% CI -0.9, 2.1)]. Patients receiving one preventive session of trauma-focused counseling showed a decrease from 3 to 12 months post-MI in avoidance symptoms with higher age (p = 0.011) and direct associations of clinical burden indices with total PTSS across both follow-ups (p's ≤ 0.043; interaction effects). Regardless of the intervention, decreases in re-experiencing, avoidance and hyperarousal symptoms from 3 to 12 months post-MI occurred, respectively, in men (p = 0.006), participants with low education (p = 0.014) and with more acute stress symptoms (p = 0.021). Peritraumatic distress (p = 0.004) and lifetime depression (p = 0.038) predicted total PTSS across both follow-ups. We conclude that PTSS were persistent in the first year after MI and not prevented by an early one-session intervention. A preventive one-session intervention of trauma-focused counseling may be inappropriate for certain subgroups of patients, although this observation needs confirmation. As predictors of the development and persistence of PTSS, sociodemographic and psychological factors could help to identify high-risk patients yet at hospital admission.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rebecca E Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Jürgen Barth
- Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Aju P Pazhenkottil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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17
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Ledermann K, von Känel R, Barth J, Schnyder U, Znoj H, Schmid JP, Meister Langraff RE, Princip M. Myocardial infarction-induced acute stress and post-traumatic stress symptoms: the moderating role of an alexithymia trait - difficulties identifying feelings. Eur J Psychotraumatol 2020; 11:1804119. [PMID: 33488995 PMCID: PMC7803082 DOI: 10.1080/20008198.2020.1804119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND It has been acknowledged that medical life-threatening experiences such as an acute myocardial infarction (MI) often lead to acute stress disorder symptoms (ASS), which in turn can result in the development of post-traumatic stress symptoms (PTSS). Previous studies have suggested an association between various traumatic experiences and alexithymia. The association of alexithymia with ASS and PTSS in patients with MI is elusive. OBJECTIVES The aim of this study was to examine the association of alexithymia with MI-induced ASS and PTSS in patients at high risk of developing PTSD. METHOD Patients (N = 154) were examined twice, once within 48 hours, and then again three months after acute MI. All patients completed the self-rating Acute Stress Disorder Scale (ASDS) within 48 hours after the cardiac event. Three months after hospital discharge, all patients completed the Toronto Alexithymia Scale (TAS-20) and underwent the Clinician-Administered PTSD Scale (CAPS), a structured interview to assess the severity of PTSS. Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted. RESULTS The linear regression model explained 23% of the variance in MI-induced PTSS-symptoms (F(6.109) = 5.58, p < 0.001, R 2 = 0.23. ASS was significantly related to PTSS severity (r (152) = p < 0.001). The scores of the TAS-20 subscale difficulties identifying feelings (DIF) were found to significantly moderate this relationship (R2 = 0.03, p = 0.04). The scores of TAS-20 subscales DDF and EOT as well as the TAS-20 total score had no influence on the relationship between ASS and PTSS (p > 0.05). CONCLUSION In MI patients with high levels of DIF, ASS predicted the development of PTSS. If replicated, the finding may inform emotion-oriented interventions to investigate whether increasing the capacity to identify feelings following acute MI could be beneficial in preventing the development of PTSS.
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Affiliation(s)
- Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.,Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
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18
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Birk JL, Cumella R, Lopez-Veneros D, Jurado A, Romero EK, Lazarov A, Kronish IM. Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial. Health Psychol 2020; 39:736-744. [PMID: 32833475 PMCID: PMC7449512 DOI: 10.1037/hea0000853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Many acute coronary syndrome (ACS) patients are nonadherent to cardiovascular medications despite their known benefits for lowering risk of recurrent cardiovascular events. Research suggests that greater cardiac-related fear of recurrence (FoR) may be associated with higher nonadherence to cardiovascular medications and avoidance of physical activity. We aim to test the effect of an intervention that targets FoR as a potentially modifiable mechanism underlying nonadherence to recommended health behaviors among patients with suspected ACS. METHOD The INFORM trial ("INvestigating Fear Of Recurrence as a modifiable Mechanism of behavior change to improve medication adherence in acute coronary syndrome patients") is a double-blind, parallel-group randomized clinical trial. It compares an 8-session, at-home, electronic tablet-delivered, cognitive bias modification training (CBMT) intervention with a sham control. Patients who experience high perceived threat at the time of presentation to the emergency department (ED) with a suspected ACS are enrolled and randomized within 6 weeks of their ED visit. The primary outcome, FoR, is measured by the adapted Concerns about Recurrent ACS Scale. The trial also tests the intervention's effect on a potential mechanism of health behavior change that is inversely correlated with fear: an expansive future time perspective. Additional outcomes include electronically measured adherence to a cardiovascular medication and self-reported physical activity. CONCLUSIONS This study takes a mechanistic approach to addressing the dangerous problem of poor health behaviors after ACS. The trial will test whether targeting FoR or future time perspective by CBMT is a promising approach to improving nonadherence after ACS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Robin Cumella
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - David Lopez-Veneros
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Ammie Jurado
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Emily K. Romero
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
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Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9:113. [PMID: 32787929 PMCID: PMC7422468 DOI: 10.1186/s40249-020-00724-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Medical care workers experienced unprecedented levels of workload and pressure since the outbreak of coronavirus disease 2019 (COVID-19). Little is known about its exact impact on medical care workers and related factors in China. This study aims to identify the psychological impact of COVID-19 on medical care workers in China. METHODS From February 23 to March 5, 2020, a cross-sectional survey was conducted among 863 medical care workers from seven provinces in China using standard questionnaires measuring adverse psychological outcomes including Impact of Event Scale-6 (IES-6), Depression, Anxiety and Stress Scale(DASS)and related psychosocial factors like perceived threat, social support and coping strategies. Exploratory Factor analysis was performed to identify the dimensions of perceived threat by study participants. Multivariate regression was used to examine the determinants of adverse psychological outcomes. RESULTS Posttraumatic stress (PTS) were prevalent in this sample of health care professionals, and 40.2% indicated positive screens for significant posttraumatic stress disorder symptoms. The proportion of having mild to extremely severe symptoms of depression, anxiety and stress were 13.6, 13.9 and 8.6%, respectively. Perceived threat and passive coping strategies were positively correlated to PTS and DASS scores, while perceived social support and active coping strategies were negatively correlated to DASS scores. Nurses were more likely to be anxious than others among medical care workers during the COVID-19 epidemic. CONCLUSIONS Adverse psychological symptoms were prevalent among medical care workers in China during the COVID-19 epidemic. Screening for adverse psychological outcomes and developing corresponding preventive measures would be beneficial in decreasing negative psychological outcomes.
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Affiliation(s)
- Ming-Yu Si
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-You Su
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wen-Jun Wang
- School of Nursing, Jining Medical University, Jining, Shandong, China
| | - Xiao-Fen Gu
- Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Li Ma
- Public Health School, Dalian Medical University, Dalian, China
| | - Jing Li
- West China School of Public Health, Sichuan University/West China Forth Hospital, Sichuan University, Chengdu, China
| | - Shao-Kai Zhang
- Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Ze-Fang Ren
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ran Ren
- Global Health Research Center, Dalian Medical University, Dalian, China
| | - Yuan-Li Liu
- School of Health Management and Policy, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan, Chaoyang District, Beijing, China.
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