1
|
Bates A, Baldwin DS, Pattison N, Moyses H, Huneke NT, Cortese S, Grocott MP, Cusack R. Eye movement desensitisation and reprocessing for survivors of life-threatening medical events. Cochrane Database Syst Rev 2024; 7:CD015640. [PMID: 39041417 PMCID: PMC11264321 DOI: 10.1002/14651858.cd015640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. SECONDARY OBJECTIVES to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD), anxiety, depression, or quality of life), or intervention (online, face-to-face, group or individual sessions).
Collapse
Affiliation(s)
- Andrew Bates
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | - Helen Moyses
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Nathan Tm Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- Dorset Healthcare University NHS Foundation Trust, Bournemouth, UK
| | - Samuele Cortese
- School of Psychology, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Michael Pw Grocott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative and Critical Care Research Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Rebecca Cusack
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| |
Collapse
|
2
|
Li YY, Peng J, Ping YY, Jia Jun W, Lu Y, Liu JJ, Xu SK, Guan LH, Huang D, Wang QB, Qian JY, Zhao ZX, Wei YB, Ge JB, Huang X. Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial. Gen Psychiatr 2024; 37:e101434. [PMID: 38645380 PMCID: PMC11029180 DOI: 10.1136/gpsych-2023-101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy (VR-CBT) could potentially improve both acute and long-term symptoms affecting their mental health. Aims We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit (ICU) during the acute stage of their illness. Methods In this single-blind randomised clinical trial, participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023. Patients who were Han Chinese aged 18-75 years were randomly assigned (1:1) via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support, or the control group to receive standard mental health support only. VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period. Assessments were done at baseline, immediately after treatment and at 3-month follow-up. The intention-to-treat analysis began in June 2023. The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale (HAM-A). Results Among 148 randomised participants, 70 were assigned to the VR-CBT group and 78 to the control group. The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention (Cohen's d=-1.27 (95% confidence interval (CI): -1.64 to -0.90, p<0.001) and 3-month follow-up (Cohen's d=-0.37 (95% CI: -0.72 to -0.01, p=0.024). Of the 70 participants who received VR-CBT, 62 (88.6%) completed the entire intervention. Cybersickness was the main reported adverse event (n=5). Conclusions Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness; the improvement was maintained at the 3-month follow-up. Trial registration number The trial was registered at www.chictr.org.cn with the identifier: ChiCTR2200066435.
Collapse
Affiliation(s)
- Yuan Yuan Li
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Juan Peng
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuan Yang Ping
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Weng Jia Jun
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yan'e Lu
- School of Nursing, Peking University, Beijing, China
| | - Jia Jia Liu
- School of Nursing, Peking University, Beijing, China
| | - Shi Kun Xu
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Hua Guan
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qi Bing Wang
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ju Ying Qian
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ze Xin Zhao
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ya Bin Wei
- Beijing Key Laboratory of Drug Dependence Research, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Jun Bo Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Xiao Huang
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| |
Collapse
|
3
|
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/ .
Collapse
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.
| |
Collapse
|
4
|
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).
Collapse
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
| |
Collapse
|
5
|
Presciutti AM, Bannon SM, Yamin JB, Newman MM, Parker RA, Elmer J, Wu O, Donnino MW, Perman SM, Vranceanu AM. The relationship between mindfulness and enduring somatic threat severity in long-term cardiac arrest survivors. J Behav Med 2023; 46:890-896. [PMID: 36892781 PMCID: PMC9995732 DOI: 10.1007/s10865-023-00405-x] [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: 12/07/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Cardiac arrest (CA) survivors experience continuous exposures to potential traumas though chronic cognitive, physical and emotional sequelae and enduring somatic threats (ESTs) (i.e., recurring somatic traumatic reminders of the event). Sources of ESTs can include the daily sensation of an implantable cardioverter defibrillator (ICD), ICD-delivered shocks, pain from rescue compressions, fatigue, weakness, and changes in physical function. Mindfulness, defined as non-judgmental present-moment awareness, is a teachable skill that might help CA survivors cope with ESTs. Here we describe the severity of ESTs in a sample of long-term CA survivors and explore the cross-sectional relationship between mindfulness and severity of ESTs. METHODS We analyzed survey data of long-term CA survivors who were members of the Sudden Cardiac Arrest Foundation (collected 10-11/2020). We assessed ESTs using 4 cardiac threat items from the Anxiety Sensitivity Index-revised (items range from 0 "very little" to 4 "very much") which we summed to create a score reflecting total EST burden (range 0-16). We assessed mindfulness using the Cognitive and Affective Mindfulness Scale-Revised. First, we summarized the distribution of EST scores. Second, we used linear regression to describe the relationship between mindfulness and EST severity adjusting for age, gender, time since arrest, COVID-19-related stress, and loss of income due to COVID. RESULTS We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% white, mean time since arrest: 6 years, 24.1% scored in the upper quarter of EST severity). Greater mindfulness (β: -30, p = 0.002), older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity. Male sex was also associated with greater EST severity (β: 0.21, p = 0.009). CONCLUSION ESTs are common among CA survivors. Mindfulness may be a protective skill that CA survivors use to cope with ESTs. Future psychosocial interventions for the CA population should consider using mindfulness as a core skill to reduce ESTs.
Collapse
Affiliation(s)
- Alexander M Presciutti
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States.
- Harvard Medical School, Department of Psychiatry, Boston, United States.
| | - Sarah M Bannon
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
| | - Jolin B Yamin
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Mary M Newman
- Sudden Cardiac Arrest Foundation, Wexford, United States
| | - Robert A Parker
- Harvard Medical School, Department of Medicine, Boston, United States
- Massachusetts General Hospital, Department of Medicine, Biostatistics Center, Boston, United States
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine, and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Ona Wu
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Boston, United States
- Harvard Medical School, Department of Radiology, Boston, United States
| | - Michael W Donnino
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, United States
| | - Ana-Maria Vranceanu
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
| |
Collapse
|
6
|
F SS, R H, A S, E J, S A, Z H, R N. Addressing PTSD in Implantable Cardioverter Defibrillator Patients: State-of-the-Art Management of ICD Shock and PTSD. Curr Cardiol Rep 2023; 25:1029-1039. [PMID: 37486571 DOI: 10.1007/s11886-023-01924-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the unique processes and treatments of post-traumatic stress in implantable cardioverter-defibrillator (ICD) patients and posits specific clinical management recommendations. RECENT FINDINGS PTSD is a common presenting problem for a prospective ICD patient and is a common response to ICD shocks. Approximately 32% of patients with sudden cardiac arrest report significant PTSD symptoms. Following ICD shock, approximately 20% experience PTSD from the shocks. Regardless, PTSD can interrupt and undermine clinical management from a cardiologist perspective and create significant disturbance in patients and families. Few cardiology clinics are outfitted to effectively manage psychological distress, in general, and PTSD, in particular. Effective management of PTSD patients can be achieved with both direct care in the cardiac clinic, as well as indirect care via multidisciplinary consultation and expertise. The importance of emotional validation, return to physical activity, and family engagement is emphasized in current management.
Collapse
Affiliation(s)
- Sears S F
- Department of Psychology, East Carolina University, Greenville, NC, USA.
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
| | - Harrell R
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Sorrell A
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Jordan E
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Anthony S
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Hashmath Z
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Nekkanti R
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| |
Collapse
|
7
|
Meinhausen C, Sanchez GJ, Robles TF, Edmondson D, Kronish IM, Hinrichs R, Jovanovic T, Sumner JA. Correlates of Skin Conductance Reactivity to Stroke-Related Trauma Reminders During Hospitalization for Stroke. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231156571. [PMID: 36814781 PMCID: PMC9940223 DOI: 10.1177/24705470231156571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Objective Although several risk factors for stroke-induced posttraumatic stress disorder (PTSD) have been identified, objective risk measures that can be detected in the acute aftermath of these events are needed. This study is the first to collect an objective measure of psychophysiological arousal-skin conductance (SC) reactivity to a trauma interview-in patients after stroke or transient ischemic attack (TIA) and investigate correlates of SC reactivity. Methods Mobile SC measurement during a resting baseline and standardized trauma interview was performed in-hospital in 98 individuals following stroke/TIA. We examined associations between several stroke-induced PTSD risk factors (sociodemographic, psychosocial, and medical characteristics) and SC reactivity to a trauma interview involving a free-response recalling of the stroke/TIA event. Results Of the sociodemographic, psychosocial, medical characteristics examined as correlates to SC reactivity to recalling the stroke/TIA event, 2 factors reflecting aspects of prior and in-hospital experience were significantly associated with this indicator of sympathetic nervous system activation. A greater cumulative trauma burden was significantly associated with greater SC reactivity (r = .23, P = .04). Additionally, individuals administered benzodiazepines in-hospital had significantly greater SC reactivity to recalling the stroke/TIA event (M = 1.51, SD = 1.52) than those who were not (M = 0.76, SD = 1.16; P = .01). Greater cumulative trauma burden remained significantly associated with greater SC reactivity when adjusting for age and in-hospital benzodiazepine administration (β=0.22, P = .04). Conclusion This study demonstrated that SC reactivity was related to both behavioral and psychological risk factors for PTSD after a stroke/TIA event. Additionally, we demonstrated the feasibility of a low-cost, mobile measurement of SC that can be conducted in-hospital in a novel patient population: individuals with a medical trauma. With this measure, we were able to identify those individuals with the greatest trauma-related sympathetic nervous system reactivity in the days following a medical trauma. Future research is needed to determine whether SC reactivity may be leveraged in the development of brief, noninvasive screening measures for enhancing PTSD risk prediction.
Collapse
Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA,Corinne Meinhausen, Department of Psychology, University of California, Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Gabriel J. Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA,Department of Psychology, St. John's University, Queens, NY, USA
| | - Theodore F. Robles
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State, University, Detroit, MI, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
8
|
Hughes JM, Brown RT, Fanning J, Raj M, Bisson ANS, Ghneim M, Kritchevsky SB. Achieving and sustaining behavior change for older adults: A Research Centers Collaborative Network workshop report. THE GERONTOLOGIST 2022; 63:gnac173. [PMID: 36473052 PMCID: PMC10474593 DOI: 10.1093/geront/gnac173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 09/04/2023] Open
Abstract
Modifying unhealthy behaviors and/or environments may improve or maintain an older adult's health. However, achieving and sustaining behavior change is challenging and depends upon clinical, social, psychological, and political domains. In an effort to highlight the multidisciplinary nature of behavior change, the NIA Research Centers Collaborative Network (RCCN) held a two-day workshop, Achieving and sustaining behavior change for older adults. The workshop was informed by the socioecological model and designed to initiate dialogue around individual, community, and systems-level determinants of behavior change. This paper summarizes key topics presented during the workshop, discusses opportunities for future research, education, and training, and recommends how each of the six NIA research centers may pursue work in behavior change for older adults.
Collapse
Affiliation(s)
- Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois, Champaign, Illinois, USA
| | - Alycia N S Bisson
- Department of Kinesiology and Community health, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Mira Ghneim
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen B Kritchevsky
- Sticht Center on Healthy Aging and Alzheimer’s Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
9
|
Plys E, Beam R, Boxer RS, Portz JD. Behavioral Health Services with Short-Stay Residents in Skilled Nursing Facilities: A Qualitative Study of Clinicians and Administrators. Clin Gerontol 2022; 45:1189-1200. [PMID: 34128773 PMCID: PMC8671564 DOI: 10.1080/07317115.2021.1937425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The perspectives of professionals involved in behavioral health (BH) services with short-stay residents in skilled nursing facilities (SNFs) are rarely captured in the literature. This study examines the real-world experiences of BH clinicians and administrators in post-acute/subacute care units in SNFs. METHODS This qualitative study used semi-structured interviews with 18 clinicians (e.g., psychologists and social workers) and five administrators (e.g., directors of social services or BH company executives) involved in BH services with short-stay SNF residents. Interviews were recorded, transcribed, and analyzed by two independent coders using conventional thematic content analysis. RESULTS Three themes emerged from the data: (1) BH needs are high among short-stay residents and families during post-acute care transitions; (2) BH services offer multiple unique opportunities to enhance post-acute/subacute care in SNFs; and (3) barriers to providing optimal BH care exist at multiple levels and require action from BH clinicians and stakeholders. CONCLUSIONS Variability in clinician roles and barriers to optimized care suggest the need for future research targeting best practices and implementation strategies for BH services with short-stay SNF residents. CLINICAL IMPLICATIONS Results identified multiple ways in which BH services may enhance resident, family, and staff outcomes, as well as the milieu in SNFs.
Collapse
Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
| | | | | | - Jennifer D. Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
| |
Collapse
|
10
|
Pothemont K, Quinton S, Jayoushe M, Jedel S, Bedell A, Hanauer SB, Mutlu EA, Taft TH. Patient Perspectives on Medical Trauma Related to Inflammatory Bowel Disease. J Clin Psychol Med Settings 2022; 29:596-607. [PMID: 34292456 DOI: 10.1007/s10880-021-09805-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
Post-traumatic stress symptoms (PTSS) in response to medical trauma are understudied in inflammatory bowel disease (IBD). Two studies identify surgery, hospitalizations, and disease severity as risk factors. We aimed to document IBD-related patient experiences and how these relate to PTSS via a qualitative study. Adult patients with confirmed IBD recruited from two gastroenterology clinics underwent a semi-structured interview with a psychologist and completed the Post Traumatic Stress Disorder Symptom Scale for DSM5 (PSSI-5). Interviews were analyzed using an interpretive phenomenological approach. Themes and subthemes with representative quotations were documented based on thematic saturation. 16 participants, five met PSSI-5 criteria for PTSD. Five themes emerged: disease uncertainty, information exchange/quality, medical procedures, surgery, and coping. Patients with IBD may experience medical PTSS from several sources. Information, communication, and trust in clinicians is vital but may be sub-optimal. Both adaptive and maladaptive coping strategies are used to mitigate PTSS.
Collapse
Affiliation(s)
| | - Sarah Quinton
- Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Majdoline Jayoushe
- Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | | | | | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | | | - Tiffany H Taft
- Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA.
| |
Collapse
|
11
|
Taft TH, McGarva J, Omprakash TA, Tomasino K, Pandit A, Mutlu EA, Hanauer SB. Hospitalization Experiences and Post-traumatic Stress in Inflammatory Bowel Disease: Opportunities for Change. Inflamm Bowel Dis 2022; 29:675-683. [PMID: 35894686 DOI: 10.1093/ibd/izac148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Medical trauma related to IBD (IBD-PTS) affects approximately 25% of patients and is associated with poor outcomes. Prior studies identify common hospitalization experiences as potentially traumatic but have not measured risk relationships for the development of IBD-PTS. We aim to investigate what aspects of hospitalizations may increase the chance of medical trauma and IBD-PTS development. METHODS Adult patients with IBD enrolled in the IBD Partners database were recruited. Study specific questionnaires included PTSD checklist, 5th edition (PCL-5), patient experience questionnaire, and items about the patient's most stressful hospitalization and nonhospital sources of medical trauma. Established criteria for the PCL-5 identified significant IBD-PTS symptoms (re-experiencing, avoidance, mood change, hyperarousal, global diagnosis). Select disease and treatment information was obtained from the main IBD Partners dataset. Univariate and multivariate statistics evaluated the relationships between hospitalization data and IBD-PTS. RESULTS There were 639 participants with at least 1 hospitalization for IBD included. Approximately two-thirds had Crohn's disease; most were White, non-Hispanic, female, middle-aged, and reported their IBD as being in remission. Forty percent of patients stated a hospitalization was a source of IBD-PTS. Frequent anxiety while hospitalized increased the odds of IBD-PTS 2 to 4 times; similar relationships existed for pain/pain control. Higher quality communication, information, and listening skills reduced the odds of IBD-PTS, albeit marginally. CONCLUSIONS Patients with IBD consistently cite hospitalizations as potential sources of medical trauma. Poorly managed anxiety and pain demonstrate the greatest chance for IBD-PTS development. Gender and racial/ethnic differences emerged for these risks. Positive interactions with the medical team may help mitigate in-hospital IBD-PTS development.
Collapse
Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Josie McGarva
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | | | - Kathryn Tomasino
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Anjali Pandit
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Ece A Mutlu
- University of Illinois, Division of Gastroenterology, Chicago, Illinois, USA
| | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| |
Collapse
|
12
|
von Känel R, Meister-Langraf RE, Zuccarella-Hackl C, Znoj H, Pazhenkottil AP, Schmid JP, Barth J, Schnyder U, Princip M. Association Between Changes in Post-hospital Cardiac Symptoms and Changes in Acute Coronary Syndrome-Induced Symptoms of Post-traumatic Stress. Front Cardiovasc Med 2022; 9:852710. [PMID: 35498017 PMCID: PMC9046908 DOI: 10.3389/fcvm.2022.852710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
BackgroundAfter acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.MethodsAt 3 (n = 154) and/or 12 months (n = 106) post-ACS, patients (n = 156, mean age 59 years, 85% men) completed a clinical interview assessing chest tightness/pain (at rest and/or during exertion), heartbeat symptoms (heart palpitations, racing of heart, heart stumbling or skipping a beat) and PTSD symptoms during the prior 4 weeks. Random mixed regression models examined the association between the onset (or remission) from 3 to 12 months in cardiac symptoms with changes in PTSD symptoms, adjusting for a range of potential predictors of ACS-induced PTSD symptoms.ResultsThe onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090; p < 0.001] and of heartbeat symptoms [0.548 (0.165, 0.931); p = 0.005] from 3 to 12 months was independently associated with an increase in total PTSD symptoms. There were also independent associations between the onset of chest tightness/pain and heartbeat symptoms with an increase in PTSD symptom clusters. Specifically, the onset of chest tightness/pain showed associations with an increase in re-experiencing [0.450 (0.167, 0.733); p = 0.027] and avoidance/numbing [0.287 (0.001, 0.574); p = 0.049]. The onset of heartbeat symptoms showed associations with an increase in re-experiencing [0.392 (0.045, 0.739); p = 0.002], avoidance/numbing [0.513 (0.161, 0.864); p = 0.004] and hyperarousal [0.355 (0.051, 0.659); p = 0.022]. An increase in the total number of cardiac symptoms (score range 0–6) was also associated with an increase in total PTSD symptoms [0.343 (0.202, 0.484); p < 0.001]. Psychotherapy in the post-hospital period moderated the association between the change in heartbeat symptoms and the change in total PTSD symptoms [−0.813 (−1.553, −0.074); p = 0.031 for interaction]; the association between the onset of heart beat symptoms and an increase in total PTSD symptoms was weaker in patients who attended psychotherapy [0.437 (−0.178, 1.052); p = 0.16] than in those who did not [0.825 (0.341, 1.309); p < 0.001].ConclusionChanges in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. ClinicalTrials.gov #NCT01781247.
Collapse
Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *Correspondence: Roland von Känel
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Zurich, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, 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
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, Gais, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
13
|
Cao X, Wu J, Gu Y, Liu X, Deng Y, Ma C. Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study. Front Psychol 2021; 12:694974. [PMID: 34970178 PMCID: PMC8712448 DOI: 10.3389/fpsyg.2021.694974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the status and risk factors of post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI) in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time (DTB) (≥92.6 min), left ventricular ejection fraction (LVEF) (<50%), smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI.
Collapse
Affiliation(s)
- Xiaocui Cao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaqi Wu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuqin Gu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuemei Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaping Deng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
14
|
Cornelius T, Birk JL, Derby L, Ellis J, Edmondson D. Effect of cohabiting partners on the development of posttraumatic stress symptoms after emergency department visits for stroke and transient ischemic attack. Soc Sci Med 2021; 281:114088. [PMID: 34118684 PMCID: PMC8238914 DOI: 10.1016/j.socscimed.2021.114088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Partners can be beneficial for patients experiencing stressful health events such as a stroke/transient ischemic attack (TIA). During such events, however, partners may exacerbate early distress. The present study tested whether having a cohabiting partner modified the association between patients' early perceptions of threat (e.g., feeling vulnerable, helpless) and longer-term posttraumatic stress symptoms (PTSS). METHODS Participants (N = 328) were drawn from an observational cohort study of patients evaluated for stroke/TIA at an urban academic hospital between 2016 and 2019. Participants self-reported emergency department (ED) threat perceptions and PTSS secondary to the stroke/TIA at three days and one month post-event. RESULTS Cohabiting partner status modified the association of ED threat with early PTSS. Patients with a cohabiting partner exhibited a positive association between ED threat and early PTSS, B = 0.12, p < .001; those without a cohabiting partner did not, B = 0.04, p = .067. A cohabiting partner was protective only for patients who initially reported low levels of ED threat, as patients with a cohabiting partner who reported low levels of ED threat also had lower early PTSS, B = -0.15, p = .016; at high levels of ED threat, a cohabiting partner was not protective, B = -0.02, p = .68. ED threat was associated with PTSS at one month, B = 0.42, p < .001, but cohabiting partner status did not modify the association. CONCLUSIONS ED threat perceptions were positively associated with early PTSS only for patients with a cohabiting partner. For patients who do not initially experience a stroke/TIA event as threatening, cohabiting partners may help patients maintain psychological equanimity.
Collapse
Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Ellis
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
15
|
Presciutti A, Newman MM, Grigsby J, Vranceanu AM, Shaffer JA, Perman SM. Associations between posttraumatic stress symptoms and quality of life in cardiac arrest survivors and informal caregivers: A pilot survey study. Resusc Plus 2021; 5:100085. [PMID: 34223351 PMCID: PMC8244463 DOI: 10.1016/j.resplu.2021.100085] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 01/20/2023] Open
Abstract
About 1 in 4 cardiac arrest survivors showed significant posttraumatic stress. Over 1 in 3 informal caregivers showed significant posttraumatic stress. Greater posttraumatic stress was associated with worse quality of life.
Aim To estimate the proportion of significant posttraumatic stress (PTS) in both cardiac survivors with good neurologic recovery and informal caregivers, and to pilot test the hypothesis that greater PTS are associated with worse quality of life (QoL) in both cardiac arrest survivors and informal caregivers of cardiac arrest survivors. Methods We distributed an online survey to survivor and caregiver members of the Sudden Cardiac Arrest Foundation. Participants provided demographic and cardiac arrest characteristics and completed the PTSD Checklist-5 (PCL-5), the Lawton Instrumental Activities of Daily Living scale, and the WHOQOL-BREF. We identified covariates through bivariate correlations or linear regressions as appropriate. Six multiple regression models (three each for survivors and caregivers) examined associations between PCL-5 scores with each QoL subscale, adjusted for covariates identified from the bivariate models. Results We included 169 survivors (mean months since arrest: 62.8, positive PTS screen: 24.9%) and 52 caregivers (mean months since arrest: 43.2, positive PTS screen: 34.6%). For survivors, the following showed significant bivariate associations with QoL: Lawton scores, daily memory problems, sex, months since arrest, age, and income; for caregivers, months since arrest, age, and income. In adjusted models, greater PCL-5 scores were associated with worse QoL (β: −0.35 to −0.53, p < .05). Conclusions Our pilot results suggest that PTS are prevalent years after the initial cardiac arrest and are associated with worse QoL in survivors and informal caregivers. Further study is needed to validate these findings in a larger, representative sample.
Collapse
Affiliation(s)
- Alex Presciutti
- University of Colorado Denver, Department of Psychology, United States.,University of Colorado School of Medicine, Department of Emergency Medicine, United States
| | | | - Jim Grigsby
- University of Colorado Denver, Department of Psychology, United States
| | | | | | - Sarah M Perman
- University of Colorado School of Medicine, Department of Emergency Medicine, United States
| |
Collapse
|
16
|
Pedowitz E, Derby L, Cruz GJ, Trainor A, Edmondson D, Cornelius T. Relationship between NIH stroke symptoms and post-traumatic stress disorder in patients evaluated for transient ischemic attack/stroke. Gen Hosp Psychiatry 2021; 70:98-102. [PMID: 33774490 PMCID: PMC8127400 DOI: 10.1016/j.genhosppsych.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) can develop after a life-threatening medical event. According to the enduring somatic treat (EST) model, internal somatic cues (e.g., rapid heart rate) may contribute to symptoms of stroke/TIA-induced PTSD. To address this possibility, the present study tested the association of stroke-induced disability with PTSD symptoms in patients treated for stroke or transient ischemic attack (TIA). METHOD Participants (n = 300) were drawn from an observational cohort study examining PTSD symptoms in patients admitted to the NewYork Presbyterian Hospital between 2015 and 2017 for a stroke/TIA. Patients self-reported acute stress symptoms in-person approximately 3 days post-stroke/TIA and PTSD symptoms via telephone one month later. Severity of stroke symptoms (i.e., stroke disability) was evaluated using the NIH Stroke Scale prior to hospital discharge. RESULTS Stroke disability had a significant, positive association with acute stress symptoms early post-stroke/TIA, B = 0.46, se = 0.15, p = .002, and with PTSD symptoms one month later, B = 0.56, se = 0.19, p = .003. CONCLUSIONS Stroke disability is positively associated with both acute distress and PTSD symptoms one month later following a stroke/TIA, supporting the hypothesis that internal somatic symptoms contribute to the development stroke/TIA-induced PTSD symptoms.
Collapse
Affiliation(s)
- Emily Pedowitz
- NYU Grossman School of Medicine, Department of Psychiatry, 1 Park Avenue, 8th Avenue, 10016, United States.
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Gaspar J. Cruz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Alison Trainor
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| |
Collapse
|
17
|
Liyanage-Don N, Birk J, Cornelius T, Sanchez G, Moise N, Edmondson D, Kronish I. Medications as Traumatic Reminders in Patients With Stroke/Transient Ischemic Attack-Induced Posttraumatic Stress Disorder. Stroke 2020; 52:321-324. [PMID: 33272128 DOI: 10.1161/strokeaha.120.031109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) symptoms are common after stroke/transient ischemic attack (TIA) and have been associated with medication nonadherence, potentially because medications serve as traumatic reminders of the prior stroke/TIA. This study examined associations between stroke/TIA-induced PTSD and aversive cognitions toward preventive medications. METHODS We enrolled a cohort of patients presenting to the emergency department with suspected stroke/TIA. One month posthospitalization, we assessed PTSD symptoms specific to the index stroke/TIA using the PTSD checklist specific and asked patients how often (1) did thinking about your stroke medication make you feel nervous or anxious?; (2) did thinking about your stroke medication make you think about your risk for future strokes?; and (3) did you skip or avoid taking your stroke medication so you would not have to think about your stroke? Logistic regression models tested the association between PTSD symptoms and each aversive cognition, adjusting for age, sex, ethnicity, and depression. RESULTS Among 408 included patients, 11.0% had elevated PTSD symptoms. These patients were more likely to report that thinking about their stroke medication made them feel nervous or anxious (37.8% versus 9.9%, P<0.001) that thinking about their stroke medication made them think about their risk for future stroke/TIA (60.0% versus 24.0%, P<0.001), and that they skipped or avoided their stroke medication to not think about their prior stroke/TIA (11.1% versus 2.2%, P=0.009). In adjusted analyses, higher PTSD checklist specific scores were associated with increased nervousness/anxiety (odds ratio, 1.33 [95% CI, 1.18-1.50], P<0.001) and thoughts of future stroke (odds ratio, 1.27 [95% CI, 1.14-1.41], P<0.001), with a trend toward significance for skipping medications to avoid reminders of stroke (odds ratio, 1.20 [95% CI, 0.99-1.44], P=0.06). CONCLUSIONS Medications may serve as traumatic reminders after stroke/TIA-induced PTSD, potentially leading to medication nonadherence.
Collapse
Affiliation(s)
- Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Gabriel Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| |
Collapse
|
18
|
Chang BP. Are There Long-term Consequences to Psychological Stress During a Medical Event? Acad Emerg Med 2020; 27:173-175. [PMID: 31651062 DOI: 10.1111/acem.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bernard P. Chang
- Department of Emergency Medicine Columbia University Medical Center New York NY
| |
Collapse
|
19
|
Moss J, Roberts MB, Shea L, Jones CW, Kilgannon H, Edmondson DE, Trzeciak S, Roberts BW. Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life-threatening Medical Emergencies. Acad Emerg Med 2020; 27:109-116. [PMID: 31650652 DOI: 10.1111/acem.13877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023]
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.
Collapse
Affiliation(s)
- Jeena Moss
- Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ
| | - Michael B. Roberts
- Institutional Research and Outcomes Assessment Philadelphia College of Osteopathic Medicine Philadelphia PA
| | - Lisa Shea
- Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ
| | - Christopher W. Jones
- Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ
| | - Hope Kilgannon
- Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ
| | | | - Stephen Trzeciak
- Department of Medicine Cooper University Health CareCooper Medical School of Rowan UniversityCamdenNJ
- Center for Humanism Cooper Medical School of Rowan University Camden NJ
| | - Brian W. Roberts
- Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ
- Center for Humanism Cooper Medical School of Rowan University Camden NJ
| |
Collapse
|
20
|
Chang BP, Cornelius T, Willey J, Edmondson D, Elkind MS, Kronish IM. Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke. Emerg Med J 2020; 37:486-488. [PMID: 31992569 DOI: 10.1136/emermed-2019-209154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, 'threat perception') is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up. METHODS This was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1-4). RESULTS 147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference. CONCLUSION Overall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.
Collapse
Affiliation(s)
- Bernard P Chang
- Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| | - Joshua Willey
- Neurology, Columbia University, New York, New York, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| | | | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
21
|
Romero EK, Abdalla M, Thanataveerat A, Alcantara C, Kronish IM, Edmondson D, Shechter A. Short Sleep Duration After Hospital Evaluation for Acute Coronary Syndrome Is Associated With Increased Risk of 6-Month Readmission. Psychosom Med 2020; 82:57-63. [PMID: 31634320 PMCID: PMC6934917 DOI: 10.1097/psy.0000000000000730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hospital readmission after acute coronary syndrome (ACS) is associated with worsened patient outcomes and financial burden. Short sleep duration is a risk factor for cardiovascular events and may therefore represent a behavioral factor that increases risk of adverse posthospitalization outcomes. This study examined whether short sleep duration in the month after hospital evaluation for ACS is associated with 6-month all-cause emergency department (ED) and hospital readmission. METHODS The current analyses entail a secondary analysis of a larger prospective observational cohort study. Sleep duration during the month after hospital evaluation for ACS was assessed subjectively and dichotomized as short (<6 hours) or not short (≥6 hours). A Cox proportional hazards model was used to assess the association between short sleep duration during the month after ACS hospital evaluation and 6-month all-cause ED/hospital readmission. RESULTS A total of 576 participants with complete data were included in analyses. Approximately 34% of participants reported short sleep duration during the month after ACS evaluation. Short sleep duration was significantly associated with 6-month all-cause ED/hospital readmission (hazard ratio = 2.03; 95% confidence interval = 1.12-3.66) in the model adjusted for age, sex, race/ethnicity, clinical severity, cardiac and renal markers, depression, acute stress, and including a sleep duration by ACS status interaction. CONCLUSIONS Short sleep duration after ACS hospital evaluation is prevalent and is associated with increased risk of all-cause readmission within 6 months of discharge. Current findings suggest that short sleep duration is an important modifiable behavioral factor to consider after hospital evaluation for ACS.
Collapse
Affiliation(s)
- Emily K. Romero
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | | | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| |
Collapse
|
22
|
Musey PI, Schultebraucks K, Chang BP. Stressing Out About the Heart: A Narrative Review of the Role of Psychological Stress in Acute Cardiovascular Events. Acad Emerg Med 2020; 27:71-79. [PMID: 31675448 DOI: 10.1111/acem.13882] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Survivors of acute cardiovascular disease (CVD) events, such as acute coronary syndrome (ACS) and stroke, may experience significant psychological distress during and following the acute event. Long-term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD), increased overall all-cause mortality, and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long-term health and to provide a theoretical framework for future work. METHODS A panel of two board-certified emergency physicians, one with a doctorate in experimental psychology, along with one PhD clinical psychologist with expertise in psychoneuroendocrinology were co-authors involved in the paper. Each author used various search strategies (e.g., PubMed, Psycinfo, Cochrane, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors RESULTS: A meta-analysis of 24 studies (N > 2,300) found the prevalence of ACS-induced PTSD at nearly 12%, while a meta-analysis of nine studies (N = 1,138) found that 25% of survivors of transient ischemic attack and stroke report PTSD symptoms. The presence of PTSD doubles 3-year risk of CVD/mortality risk in ACS survivors. Cardiac patients treated during periods of ED overcrowding, hallway care, and perceived poor clinician-patient communication appear at greater risk for subsequent PTSD. CONCLUSIONS Psychological stress is often present in patients undergoing evaluation for acute CVD events. Understanding such associations provides a foundation to appreciate the potential contribution of psychological variables on acute and long-term cardiovascular recovery, while also stimulating future areas of research and discovery.
Collapse
Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Bernard P. Chang
- Department of Emergency Medicine Columbia University Medical Center New York NY
| |
Collapse
|
23
|
Chang BP, Cato KD, Cassai M, Breen L. Clinician burnout and its association with team based care in the Emergency Department. Am J Emerg Med 2019; 37:2113-2114. [PMID: 31255426 DOI: 10.1016/j.ajem.2019.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Bernard P Chang
- 622 West 168th Street, Department of Emergency Medicine, VC 2nd Floor Suite 260, New York, NY 10032, USA.
| | - Kenrick Dwain Cato
- Department of Nursing Research and Scholarship, Columbia University, New York, NY, USA
| | - Mary Cassai
- Clinical Applications, New York-Presbyterian, The University Hospital of Columbia and Cornell, New York, NY, USA
| | - Lorna Breen
- 622 West 168th Street, Department of Emergency Medicine, VC 2nd Floor Suite 260, New York, NY 10032, USA.
| |
Collapse
|
24
|
Birk JL, Sumner JA, Haerizadeh M, Heyman-Kantor R, Falzon L, Gonzalez C, Gershengoren L, Shapiro P, Edmondson D, Kronish IM. Early interventions to prevent posttraumatic stress disorder symptoms in survivors of life-threatening medical events: A systematic review. J Anxiety Disord 2019; 64:24-39. [PMID: 30925334 PMCID: PMC6504609 DOI: 10.1016/j.janxdis.2019.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/11/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
Abstract
Post-traumatic stress disorder (PTSD) induced by life-threatening medical events has been associated with adverse physical and mental health outcomes, but it is unclear whether early interventions to prevent the onset of PTSD after these events are efficacious. We conducted a systematic review to address this need. We searched six biomedical electronic databases from database inception to October 2018. Eligible studies used randomized designs, evaluated interventions initiated within 3 months of potentially traumatic medical events, included adult participants, and did not have high risk of bias. The 21 included studies (N = 4,486) assessed a heterogeneous set of interventions after critical illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type interventions were assessed. Four of the psychological interventions emphasizing cognitive behavioral therapy or meaning-making, 1 other-type palliative care intervention, and 1 pharmacological-only intervention (hydrocortisone administration) were efficacious at reducing PTSD symptoms relative to control. One early, in-hospital counseling intervention was less efficacious at lowering PTSD symptoms than an active control. Clinical and methodological heterogeneity prevented quantitative pooling of data. While several promising interventions were identified, strong evidence of efficacy for any specific early PTSD intervention after medical events is currently lacking.
Collapse
Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jennifer A. Sumner
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Mytra Haerizadeh
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Reuben Heyman-Kantor
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Christopher Gonzalez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Liliya Gershengoren
- Department of Psychiatry, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - Peter Shapiro
- Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
25
|
Cornelius T, Meli L, Thorson KR, Chang BP, Edmondson D, West TV. Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat. Gen Hosp Psychiatry 2019; 56:42-49. [PMID: 30578986 PMCID: PMC6353683 DOI: 10.1016/j.genhosppsych.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Relationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients' experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD). METHOD Participants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories were created representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one. RESULTS Patients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05. CONCLUSIONS Close others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.
Collapse
Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States of America.
| | - Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States of America.
| | | | - Bernard P. Chang
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States of America.
| | - Tessa V. West
- Department of Psychology, New York University, New York, NY
| |
Collapse
|
26
|
Edmondson D, Birk JL, Ho VT, Meli L, Abdalla M, Kronish IM. A challenge for psychocardiology: Addressing the causes and consequences of patients' perceptions of enduring somatic threat. AMERICAN PSYCHOLOGIST 2018; 73:1160-1171. [PMID: 30525797 PMCID: PMC6619434 DOI: 10.1037/amp0000418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The enduring somatic threat (EST) model of posttraumatic stress disorder (PTSD) due to life-threatening medical events suggests that PTSD-like symptoms represent patients' sensitization to cues of ongoing threat in the body. In this article, we review research on the prevalence and consequences of such reactions in cardiovascular disease patients, discuss early tests of the EST model, and then report a new test of the EST model in 143 patients enrolled during their first acute coronary syndrome (ACS; i.e., non-ST elevation myocardial infarction or unstable angina-colloquially, "heart attack"). Invasive coronary revascularization procedures are commonly used to reduce secondary ACS risk and may reduce patients' EST, as revascularized patients often report being "cured." We assessed ACS patients' initial threat perceptions during emergency department (ED) evaluation and followed them for 1 month for PTSD symptoms (specific for ACS, by telephone). We compared PTSD symptoms in participants who were revascularized (n = 65), catheterized but not revascularized (n = 35), and medically managed (n = 43). PTSD symptoms were lower for revascularized versus medically managed participants (B = -5.32, 95% confidence interval [-9.77, -0.87]), t(98.19) = -2.37, p = .020. In a multiple regression model adjusted for clinical and psychosocial covariates, the interaction of threat perception in the ED and ACS management group was significant (greater ED threat predicted greater 1-month PTSD symptoms only in medically managed participants). These findings offer further support for the EST model and suggest that psychological interventions to preempt patients' development of EST should be considered in the hospital. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Vivian T Ho
- Department of Medicine, College of Physicians & Surgeons, Columbia University
| | - Laura Meli
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Marwah Abdalla
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| |
Collapse
|
27
|
Zhu DR, Julian J, Lee SJA, Thanataveerat A, Sumner JA. Patterns of peritraumatic threat perceptions in patients evaluated for suspected acute coronary syndrome according to prior and current posttraumatic stress symptoms. Gen Hosp Psychiatry 2018; 53:119-124. [PMID: 29789141 PMCID: PMC6388421 DOI: 10.1016/j.genhosppsych.2018.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prior posttraumatic stress disorder (PTSD) and elevated threat perceptions predict posttraumatic psychopathology after evaluation for acute coronary syndrome (ACS), but most research has measured threat retrospectively. We investigated how threat perceptions during ACS evaluation in the emergency department (ED) and upon recall were associated with posttraumatic psychopathology burden due to prior trauma and the suspected ACS. METHODS Perceived threat was assessed in the ED, and ED threat recall was assessed upon inpatient transfer/discharge, along with acute stress disorder (ASD) symptoms due to suspected ACS and PTSD symptoms due to prior trauma. The sample comprised 894 participants (mean age = 60.7 ± 13.1 years; 46.8% female; 56.3% Hispanic; 20.5% Black). One-way ANOVAs examined how those with consistent posttraumatic psychopathology (prior PTSD/ASD; 14.8%), prior posttraumatic psychopathology (prior PTSD/no ASD; 6.8%), new-onset posttraumatic psychopathology (no PTSD/ASD; 15.7%), or no posttraumatic psychopathology (no PTSD/no ASD; 62.8%) differed in threat perception, threat recall, and their discrepancy. RESULTS Threat perception scores ranged from 6 to 24. Participants with consistent posttraumatic psychopathology had higher threat perceptions (M = 14.01) than those with prior posttraumatic psychopathology (M = 12.02) and new-onset posttraumatic psychopathology (M = 12.21) (ps ≤ 0.001); the latter two did not differ significantly but had higher threat perceptions than those with no posttraumatic psychopathology (M = 9.84) (p < .001). Similar results were observed for threat recall (p < .001). The new-onset posttraumatic psychopathology group also had a greater increase in perceived threat versus the no posttraumatic psychopathology group (p = .06). Results were similar adjusting for potential confounders. CONCLUSIONS Assessing threat perceptions during ACS evaluation and hospitalization may help identify those at risk for emotional difficulties post-ACS.
Collapse
Affiliation(s)
- Deanna R Zhu
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| | - Sung J A Lee
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| |
Collapse
|
28
|
Presciutti A, Verma J, Pavol M, Anbarasan D, Falo C, Brodie D, Rabbani LE, Roh DJ, Park S, Claassen J, Agarwal S. Posttraumatic stress and depressive symptoms characterize cardiac arrest survivors' perceived recovery at hospital discharge. Gen Hosp Psychiatry 2018; 53:108-113. [PMID: 29776732 DOI: 10.1016/j.genhosppsych.2018.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the hypothesis that posttraumatic stress and depressive symptoms, not cognitive or functional impairment, are associated with cardiac arrest survivors' negative recovery perceptions at hospital discharge. METHODS Prospective observational cohort of cardiac arrest patients admitted between 9/2015-5/2017. Survival to discharge with sufficient mental status to complete a psychosocial interview was the main inclusion criterion. Perceived recovery was assessed through the question, "Do you feel that you have made a complete recovery from your arrest?" The following measures were examined as potential correlates of perceived recovery: Repeatable Battery for Assessment of Neuropsychological Status, Modified Lawton Physical Self-Maintenance Scale, Barthel Index, Modified Rankin Scale, Cerebral Performance Category, Center for Epidemiological Studies-Depression (CES-D), and PTSD Checklist-Specific (PCL-S). Logistic regression evaluated associations between perceived recovery and potential correlates of recovery. RESULTS 64/354 patients (58% men, 48% white, mean age 52 ± 17) were included. 67% (n = 43) had a negative recovery perception. There were no differences among patients' cognitive and functional domains. In individual models, patients with higher PCL-S and CES-D scores were more likely to have a negative recovery perception after adjusting for age and gender (OR: 1.2, 95% CI [1.1, 1.4], p = 0.003) and (OR: 1.1, 95% CI [1.0, 1.1], p = 0.05). CONCLUSIONS Within one month after a cardiac arrest event, survivors' negative recovery perceptions are associated with psychological distress.
Collapse
Affiliation(s)
- Alex Presciutti
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Jayati Verma
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Marykay Pavol
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Deepti Anbarasan
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Cristina Falo
- Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Daniel Brodie
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Leroy E Rabbani
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - David J Roh
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Soojin Park
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Sachin Agarwal
- Department of Neurology, Columbia University Medical Center, New York, NY, United States.
| |
Collapse
|
29
|
Monane R, Sanchez GJ, Kronish IM, Edmondson D, Diaz KM. Post-traumatic stress disorder symptoms and aversive cognitions regarding physical activity in patients evaluated for acute coronary syndrome. Eur J Prev Cardiol 2017; 25:402-403. [PMID: 29198138 DOI: 10.1177/2047487317746255] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rachel Monane
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, USA
| |
Collapse
|
30
|
Husain SA, Edmondson D, Kautz M, Umland R, Kronish IM. Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications. J Behav Med 2017; 41:261-268. [PMID: 29204908 DOI: 10.1007/s10865-017-9906-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) after acute medical events is associated with medication nonadherence. The mechanisms of PTSD-related nonadherence are poorly understood. We tested whether patients with elevated PTSD symptoms induced by suspected acute coronary syndrome (ACS) were more likely to have aversive cognitions towards cardiovascular medications. We enrolled a consecutive cohort of patients who presented to the emergency department with suspected ACS. One month after discharge, ACS-induced PTSD symptoms were assessed using the PTSD Checklist (PCL-S), and patients were asked "how often did" (1) "you miss your heart medication because you did not want to be reminded about your heart problem"; (2) "thinking about your heart medication make you feel nervous or anxious"; and (3) "thinking about your heart medication make you think about your risk for future heart problems." Logistic regression was used to determine the association between elevated PTSD symptoms and each aversive cognition, adjusting for age, sex, race, ethnicity, education, depression, and ACS status. Of 424 patients included, 15.8% had elevated PTSD symptoms (PCL-S ≥ 34). In adjusted analyses, higher PCL-S scores were associated with missing medications to avoid reminders of heart disease (OR 1.22 per 5-point PCL-S increase, 95%CI 1.07-1.40), as well as anxiety (OR 1.34, 95%CI 1.19-1.51) and thoughts of future risk (OR 1.19, 95%CI 1.08-1.32) when thinking about cardiovascular medications. We concluded that patients with elevated PTSD symptoms following suspected ACS were more likely to report aversive cognitions about their cardiovascular medications, suggesting that medications can act as traumatic reminders of the cardiac event and ongoing risk in this group.
Collapse
Affiliation(s)
- S Ali Husain
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Marin Kautz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Redeana Umland
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
| |
Collapse
|
31
|
Meli L, Kautz M, Julian J, Edmondson D, Sumner JA. The role of perceived threat during emergency department cardiac evaluation and the age-posttraumatic stress disorder link. J Behav Med 2017; 41:357-363. [PMID: 29188468 DOI: 10.1007/s10865-017-9904-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/15/2017] [Indexed: 01/26/2023]
Abstract
Evaluation for acute coronary syndrome (ACS) can trigger posttraumatic stress symptoms (PSS). Research suggests that younger, versus older, individuals may be at elevated risk for PSS after ACS evaluation. It has been proposed that younger individuals may be at greater risk because they perceive the suspected ACS event as more threatening than their older counterparts; however, this has yet to be tested. We examined whether perceived threat during ACS evaluation mediated the association between age and PSS after ACS evaluation in an observational cohort study of patients presenting to the emergency department (ED) with suspected ACS. Demographics and perceived threat were assessed in the ED. PSS were measured upon inpatient transfer or by phone 3 days later. The analytic sample comprised 871 adult participants. Multiple linear regression was used to examine (1) associations of age and perceived threat with PSS and (2) whether perceived threat mediated the association. Bootstrapping with percentile-based confidence intervals (CIs) was used to test the indirect effect. Each year of age was associated with lower PSS (b = - 0.12, p < .001), independent of covariates. Older age was associated with lower perceived threat during ACS evaluation (b = - 0.05, p < .001). Greater threat perceptions predicted greater PSS (b = 0.94, p < .0001). The indirect effect (- 0.04) was statistically significant (95% CI - 0.07, - 0.02). Younger, versus older, individuals are at risk for greater PSS after ACS evaluation, and elevated perceived threat partially mediated this association. Understanding age differences in PSS development risk and the potential impact of age on threat perceptions may help inform ED treatment.
Collapse
Affiliation(s)
- Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH 9-317, New York, NY, 10032, USA.
| | - Marin Kautz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH 9-311, New York, NY, 10032, USA
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH 9-303, New York, NY, 10032, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH 9-317, New York, NY, 10032, USA
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH 9-315, New York, NY, 10032, USA
| |
Collapse
|