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Rhodes A, Wilson C, Zelenkov D, Adams K, Poyant JO, Han X, Faugno A, Montalvo C. "The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist". J Intensive Care Med 2024:8850666241275582. [PMID: 39169853 DOI: 10.1177/08850666241275582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.
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Affiliation(s)
- Allison Rhodes
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | | | - Kathryne Adams
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | - Xuan Han
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Anthony Faugno
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Cristina Montalvo
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
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Shen J, Valentim W, Friligkou E, Overstreet C, Choi K, Koller D, O'Donnell CJ, Stein MB, Gelernter J, Lv H, Sun L, Falcone GJ, Polimanti R, Pathak GA. Genetics of posttraumatic stress disorder and cardiovascular conditions using Life's Essential 8, Electronic Health Records, and Heart Imaging. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.20.24312181. [PMID: 39228734 PMCID: PMC11370495 DOI: 10.1101/2024.08.20.24312181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
BACKGROUND Patients with post-traumatic stress disorder (PTSD) experience higher risk of adverse cardiovascular (CV) outcomes. This study explores shared loci, and genes between PTSD and CV conditions from three major domains: CV diagnoses from electronic health records (CV-EHR), cardiac and aortic imaging, and CV health behaviors defined in Life's Essential 8 (LE8). METHODS We used genome-wide association study (GWAS) of PTSD (N=1,222,882), 246 CV diagnoses based on EHR data from Million Veteran Program (MVP; N=458,061), UK Biobank (UKBB; N=420,531), 82 cardiac and aortic imaging traits (N=26,893), and GWAS of traits defined in the LE8 (N = 282,271 ∼ 1,320,016). Shared loci between PTSD and CV conditions were identified using local genetic correlations (rg), and colocalization (shared causal variants). Overlapping genes between PTSD and CV conditions were identified from genetically regulated proteome expression in brain and blood tissues, and subsequently tested to identify functional pathways and gene-drug targets. Epidemiological replication of EHR-CV diagnoses was performed in AllofUS cohort (AoU; N=249,906). RESULTS Among the 76 PTSD-susceptibility risk loci, 33 loci exhibited local rg with 45 CV-EHR traits (|rg|≥0.4), four loci with eight heart imaging traits(|rg|≥0.5), and 44 loci with LE8 factors (|rg|≥0.36) in MVP. Among significantly correlated loci, we found shared causal variants (colocalization probability > 80%) between PTSD and 17 CV-EHR (in MVP) at 11 loci in MVP, that also replicated in UKBB and/or other cohorts. Of the 17 traits, the observational analysis in the AoU showed PTSD was associated with 13 CV-EHR traits after accounting for socioeconomic factors and depression diagnosis. PTSD colocalized with eight heart imaging traits on 2 loci and with LE8 factors on 31 loci. Leveraging blood and brain proteome expression, we found 33 and 122 genes, respectively, shared between PTSD and CVD. Blood proteome genes were related to neuronal and immune processes, while the brain proteome genes converged on metabolic and calcium-modulating pathways (FDR p <0.05). Drug repurposing analysis highlighted DRD2, NOS1, GFAP, and POR as common targets of psychiatric and CV drugs. CONCLUSION PTSD-CV comorbidities exhibit shared risk loci, and genes involved in tissue-specific regulatory mechanisms.
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Li A, Ji S, Nie Y, Chi M, Wang N, Zhu Z, Li S, Hou Y. The Content and Nature of Rumination in Chinese Young and Middle-Aged Patients with Acute Coronary Syndrome: A Qualitative Study. Healthcare (Basel) 2024; 12:1651. [PMID: 39201209 PMCID: PMC11353411 DOI: 10.3390/healthcare12161651] [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: 06/25/2024] [Revised: 08/09/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Individuals have different rumination patterns after experiencing traumatic events in different cultural backgrounds and situations. This study aimed to explore the experience of Chinese young and middle-aged patients with acute coronary syndrome (ACS) to understand the content and nature of their rumination. Sixteen participants were selected using the purposive sampling method in the First Affiliated Hospital of Soochow University from May 2023 to December 2023. Data were collected using semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method. The participants went through two successive stages: non-adaptive rumination and adaptive rumination. During the initial admission phase, all the participants experienced varying degrees of non-adaptive rumination. Non-adaptive rumination included four sub-themes: worry or anxiety of daily activities and medical therapy (37.50%), fear of unpredictable outcomes and death (37.50%), sadness of maladjustment (25.00%), and remorse of carelessness (12.50%). During the period of stable condition and pre-discharge, the participants received health education and gradually all transitioned to adaptive rumination. Adaptive rumination included four sub-themes: tracing of disease processes (100%), enhancement of disease cognition (81.25%), improvement of health awareness (62.50%), and adjustment of lifestyle cognition (100%). In conclusion, although the Chinese young and middle-aged patients with ACS experienced negative emotions after a traumatic cardiac event, they gradually made positive changes, and optimism and information support played important roles in this transition. The results of this study provide a fundamental understanding of rumination experiences in Chinese young and middle-aged patients with ACS and provide new data for healthcare providers when designing intervention programs to enhance post-traumatic growth in these patients.
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Affiliation(s)
- Anan Li
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Siying Ji
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Yangfan Nie
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Meixuan Chi
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Naijuan Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Zhaoying Zhu
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Shan Li
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
| | - Yunying Hou
- Department of Nursing, The First Affiliated Hospital of Soochow University, No.188, Shizi Street, Gusu District, Suzhou 215006, China; (A.L.)
- School of Nursing, Suzhou Medical College of Soochow University, No.333, Ganjiang East Road, Gusu District, Suzhou 215006, China
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Lim A, Pasini M, Yun S, Gill J, Koirala B. Genetic association between post-traumatic stress disorder and cardiovascular disease: A scoping review. J Psychiatr Res 2024; 178:331-348. [PMID: 39191203 DOI: 10.1016/j.jpsychires.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/05/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder associated with adverse long-term health outcomes, including cardiovascular disease (CVD). Despite growing evidence that PTSD is positively associated with CVD, the biological mechanisms underlying this association are poorly understood. This review provides an overview of the current state of science on the genetic association between PTSD and CVD. MATERIAL AND METHODS This scoping review identified studies from Pubmed, Embase, PsycINFO, and Web of Science. The search terms were a combination of PTSD, CVD/CVD-related traits, and a set of genetic molecules and related terms. This review followed the PRISMA Extension for Scoping Reviews guidelines. Eligible criteria included original studies that have genetic factors related to PTSD or CVD, conducted in humans, written in English, and published between 2003 and 2023 in peer-reviewed journals. RESULTS A total of twenty-three studies were included; PTSD correlated with genetic variants in CVD-related traits and gene expression in regulatory pathways contributing to CVD development. Common CVD-related traits involved in genetic associations with PTSD were inflammation, cellular aging, increased blood pressure, hypothalamus-pituitary-adrenal axis dysregulation, metabolic syndrome, and oxidative stress. These traits may explain potential underlying mechanisms between PTSD and CVD. Evidence of a causal relationship between the two diseases was insufficient. DISCUSSION PTSD and CVD/CVD-related traits are genetically associated. Further research is needed to comprehensively explore gene-environment interactions and the cumulative impact of behavioral and psychological factors on the pathophysiological mechanisms between PTSD and CVD.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA.
| | - Mia Pasini
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Sijung Yun
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Jessica Gill
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Binu Koirala
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
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Sayde GE, Shapiro PA, Kronish I, Agarwal S. A shift towards targeted post-ICU treatment: Multidisciplinary care for cardiac arrest survivors. J Crit Care 2024; 82:154798. [PMID: 38537526 DOI: 10.1016/j.jcrc.2024.154798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 06/01/2024]
Abstract
Intensive Care Unit (ICU) survivorship comprises a burgeoning area of critical care medicine, largely due to our improved understanding of and concern for patients' recovery trajectory, and efforts to mitigate the post-acute complications of critical illness. Expansion of care beyond hospitalization is necessary, yet evidence for post-ICU clinics remains limited and mixed, as both interventions and target populations studied to date are too heterogenous to meaningfully demonstrate efficacy. Here, we briefly present the existing evidence and limitations related to post-ICU clinics, identify cardiac arrest survivors as a unique ICU subpopulation warranting further investigation and treatment, and propose a clinical framework that addresses the multifaceted needs of this well-defined patient population.
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Affiliation(s)
- George E Sayde
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Peter A Shapiro
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, PH9-311, New York, NY 10032, USA.
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care and Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 8GS-300, New York, NY 10032, USA.
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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).
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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
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Ten Brink M, Shechter A, Cornelius T, Rojas DA, Murdock ME, Schwartz JE, Lee SAJ, Birk JL. Cardiac-induced PTSD symptoms predict shorter sleep a month after acute coronary syndrome evaluation. Gen Hosp Psychiatry 2024; 89:103-105. [PMID: 38599946 DOI: 10.1016/j.genhosppsych.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Maia Ten Brink
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America; Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Danielle A Rojas
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Margaret E Murdock
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America; Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Sung A J Lee
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Corrao G, Monzio Compagnoni M, Conflitti C, Lora A. Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare? Eur J Public Health 2024; 34:584-591. [PMID: 38268304 PMCID: PMC11161155 DOI: 10.1093/eurpub/ckae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. METHODS In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. RESULTS Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. CONCLUSION The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.
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Affiliation(s)
- Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Claudia Conflitti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Harrison DJ, Kay J, Jacobsen RM, Londono-Obregon C, Yeung E, Kelly SL, Poteet A, Levek C, Landzberg MJ, Wallrich M, Khanna A. The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD. Am J Cardiol 2024; 219:9-16. [PMID: 38458583 DOI: 10.1016/j.amjcard.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.
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Affiliation(s)
- David J Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | - Joseph Kay
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Roni M Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Camila Londono-Obregon
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah L Kelly
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Ann Poteet
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
| | - Claire Levek
- University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Landzberg
- Boston Adult Congenital Heart (B.A.C.H.) Program, Boston Children's Hospital, Brigham and Women's Hospital, Boston, Massachisetts
| | - Molly Wallrich
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
| | - Amber Khanna
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
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Ai AL, Appel HB, Lin CJ. Sex and Psychosocial Differences in Acute Stress Symptoms Prior to Open-Heart Surgery. Int J Behav Med 2024:10.1007/s12529-024-10287-1. [PMID: 38730199 DOI: 10.1007/s12529-024-10287-1] [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] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Acute stress symptoms can occur while cardiac patients await open-heart surgery (OHS). The distress leads to poor outcomes. This study aimed to investigate the association of sex and psychosocial factors (quality-of-life and character strengths). METHOD Our study cohort included 481 pre-OHS patients (female 42%; mean age 62 years). Medical indices/factors were obtained from the Society of Thoracic Surgeon's national database. Multiple regression analyses were performed following pre-planned steps and adjusting medical factors. RESULTS Our findings revealed that sex differences in trauma-related symptoms were associated with poor mental well-being, alongside comorbidities. Both mental well-being and comorbidity factors were directly related to acute stress symptoms, while dispositional optimism had an inverse association with this outcome. CONCLUSION To improve OHS outcomes, our findings suggest healthcare providers be attentive to pre-OHS acute stress symptoms, pay greater attention to the emotional well-being of their female patients, and develop supportive interventions to enhance personality strengths.
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Affiliation(s)
- Amy L Ai
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
| | - Hoa B Appel
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
- University of Washington Bothell, School of Nursing and Health Studies, 17927 113th Ave NE, Bothell, WA, 98011, USA.
| | - Chyongchiou J Lin
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
- The Ohio State University, College of Nursing, 1577 Neil Avenue, Columbus, OH, 43210, USA.
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12
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Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
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13
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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.
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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
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14
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Susinski S, Bouchard K, Stragapede E, Dozois S, Sterling E, Tulloch H. Psychological interventions targeting mental health and stress among females with cardiac disease: a scoping review. Can J Physiol Pharmacol 2024. [PMID: 38587177 DOI: 10.1139/cjpp-2023-0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.
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Affiliation(s)
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Elisa Stragapede
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Sophie Dozois
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Evan Sterling
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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15
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Sumner JA, Kim ESH, Wood MJ, Chi G, Nolen J, Grodzinsky A, Gornik HL, Kadian‐Dodov D, Wells BJ, Hess CN, Lewey J, Tam L, Henkin S, Orford J, Wells G, Kumbhani DJ, Lindley KJ, Gibson CM, Leon KK, Naderi S. Posttraumatic Stress Disorder After Spontaneous Coronary Artery Dissection: A Report of the International Spontaneous Coronary Artery Dissection Registry. J Am Heart Assoc 2024; 13:e032819. [PMID: 38533943 PMCID: PMC11179755 DOI: 10.1161/jaha.123.032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry-based cohort, we documented prevalence of lifetime and past-month SCAD-induced PTSD, as well as related treatment seeking, and examined a range of health-relevant correlates of SCAD-induced PTSD. METHODS AND RESULTS Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD-induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD-induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD-induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past-month PTSD. Of 811 patients ever reporting any SCAD-induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD-induced PTSD diagnoses reported never receiving trauma-related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past-month PTSD symptom severity in multivariable regression models. Greater past-month SCAD-induced PTSD symptoms were associated with greater past-week sleep disturbance and worse past-month disease-specific health status when adjusting for various risk factors. CONCLUSIONS Given the high prevalence of SCAD-induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496687.
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Affiliation(s)
- Jennifer A. Sumner
- Department of PsychologyUniversity of California, Los AngelesLos AngelesCAUSA
| | - Esther S. H. Kim
- Division of Cardiovascular Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Malissa J. Wood
- Division of CardiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Gerald Chi
- PERFUSE Study Group, Cardiovascular Division, Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | | | - Anna Grodzinsky
- Saint Luke’s Mid America Heart Institute, Muriel I. Kauffman Women’s Heart CenterUniversity of Missouri‐Kansas CityKansas CityMOUSA
| | - Heather L. Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Division of Cardiovascular MedicineCase Western Reserve UniversityClevelandOHUSA
| | - Daniella Kadian‐Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie‐Josée and Henry R. Kravis Center for Cardiovascular HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Bryan J. Wells
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGAUSA
| | - Connie N. Hess
- Division of Cardiology, Department of MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Jennifer Lewey
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Lori Tam
- Providence Heart InstitutePortlandORUSA
| | - Stanislav Henkin
- Heart and Vascular CenterDartmouth‐Hitchcock Medical CenterLebanonNHUSA
| | - James Orford
- Intermountain Heart Institute, Intermountain Medical CenterMurrayUTUSA
| | - Gretchen Wells
- Division of Cardiovascular Medicine, Department of MedicineUniversity of KentuckyLexingtonKYUSA
| | - Dharam J. Kumbhani
- Division of Cardiology, Department of Internal MedicineUT Southwestern Medical CenterDallasTXUSA
| | - Kathryn J. Lindley
- Division of Cardiovascular Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - C. Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | | | - Sahar Naderi
- Division of CardiologyKaiser PermanenteSan FranciscoCAUSA
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16
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Chen JJ, Jain J, Merker JB, Webber TK, Huffman JC, Seligowski AV. The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms. Eur J Psychotraumatol 2024; 15:2320993. [PMID: 38445477 PMCID: PMC10919301 DOI: 10.1080/20008066.2024.2320993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones - estradiol and progesterone - have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.
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Affiliation(s)
| | - Jahnvi Jain
- UT Health McGovern Medical School, Houston, TX, USA
| | - Julia B. Merker
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | | | - Jeffery C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
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17
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Seligowski AV, Grewal SS, Abohashem S, Zureigat H, Qamar I, Aldosoky W, Gharios C, Hanlon E, Alani O, Bollepalli SC, Armoundas A, Fayad ZA, Shin LM, Osborne MT, Tawakol A. PTSD increases risk for major adverse cardiovascular events through neural and cardio-inflammatory pathways. Brain Behav Immun 2024; 117:149-154. [PMID: 38218349 PMCID: PMC10932910 DOI: 10.1016/j.bbi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
While posttraumatic stress disorder (PTSD) is known to associate with an elevated risk for major adverse cardiovascular events (MACE), few studies have examined mechanisms underlying this link. Recent studies have demonstrated that neuro-immune mechanisms, (manifested by heightened stress-associated neural activity (SNA), autonomic nervous system activity, and inflammation), link common stress syndromes to MACE. However, it is unknown if neuro-immune mechanisms similarly link PTSD to MACE. The current study aimed to test the hypothesis that upregulated neuro-immune mechanisms increase MACE risk among individuals with PTSD. This study included N = 118,827 participants from a large hospital-based biobank. Demographic, diagnostic, and medical history data collected from the biobank. SNA (n = 1,520), heart rate variability (HRV; [n = 11,463]), and high sensitivity C-reactive protein (hs-CRP; [n = 15,164]) were obtained for a subset of participants. PTSD predicted MACE after adjusting for traditional MACE risk factors (hazard ratio (HR) [95 % confidence interval (CI)] = 1.317 [1.098, 1.580], β = 0.276, p = 0.003). The PTSD-to-MACE association was mediated by SNA (CI = 0.005, 0.133, p < 0.05), HRV (CI = 0.024, 0.056, p < 0.05), and hs-CRP (CI = 0.010, 0.040, p < 0.05). This study provides evidence that neuro-immune pathways may play important roles in the mechanisms linking PTSD to MACE. Future studies are needed to determine if these markers are relevant targets for PTSD treatment and if improvements in SNA, HRV, and hs-CRP associate with reduced MACE risk in this patient population.
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Affiliation(s)
- Antonia V Seligowski
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Simran S Grewal
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Iqra Qamar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wesam Aldosoky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erin Hanlon
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Omar Alani
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Antonis Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA; Broad Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychology, Tufts University, Medford, MA, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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18
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Yang C, Offen S, Saw J. What Is New in Spontaneous Coronary Artery Dissection? CJC Open 2024; 6:417-424. [PMID: 38487071 PMCID: PMC10935686 DOI: 10.1016/j.cjco.2023.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 03/17/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a condition that leads to tearing of the coronary vessel wall in the absence of trauma, iatrogenic injury, or atherosclerosis. SCAD is an important cause of myocardial infarction in young women, leading to significant cardiovascular morbidity and mortality. Within cohorts of women aged around 50 years on average, who experience acute coronary syndrome, the prevalence of SCAD is 22.5%- 35%. Over the past decade, SCAD research has expanded rapidly, leading to improved understanding of this condition. In this review, we provide a summary of the current body of knowledge, highlight areas of ongoing research, and identify existing knowledge gaps. Specifically, we provide a focused update on the pathogenesis of SCAD, including genetic and associated conditions, clinical presentation and diagnosis, prognosis, and short-term and long-term management. Highlighted areas include the following: insights from recent genome-wide association studies; intracoronary imaging for the diagnosis of SCAD; the role of cardiac computed tomography angiography to assess for vessel healing; revascularization strategies and challenges; cardiogenic shock in SCAD; and the increasingly recognized burden of anxiety, depression, and posttraumatic stress disorder among SCAD patients.
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Affiliation(s)
- Cathevine Yang
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophie Offen
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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20
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Birk JL, Cornelius T, Kronish IM, Shechter A, Diaz KM, Schwartz JE, Garcia OG, Cruz GJ, Shaw K, Sanchez GJ, Agarwal S, Edmondson D. Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study. Gen Hosp Psychiatry 2024; 86:103-107. [PMID: 38181710 PMCID: PMC10872378 DOI: 10.1016/j.genhosppsych.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization. METHOD In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device. RESULTS Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients. CONCLUSIONS Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA.
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Othanya G Garcia
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gaspar J Cruz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Kaitlin Shaw
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA; Psychology Department, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY 8GS-300, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
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21
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Bogolepova AN. [Cognitive impairment in post-traumatic stress disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:69-74. [PMID: 38884432 DOI: 10.17116/jnevro202412405169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a common mental health disorder, with an incidence of up to 12.5% among primary care patients. Most often, PTSD is detected in combat veterans, victims of terrorist attacks and terror, but it can also be a consequence of traumatic brain injury and medical interventions. Impaired cognitive functioning is a key feature of PTSD, including attention deficits and reduced processing speed, executive dysfunction, and impairments in verbal learning and memory. Cognitive impairments in PTSD are significantly persistent and are largely similar in nature to neuropsychological impairments in neurodegenerative pathology. Possible pathogenetic mechanisms underlying PTSD are the development of neuroinflammation, oxidative stress and decreased production of neurotrophic factors. One of the promising areas of treatment is the use of Cerebrolysin, which has powerful neurotrophic and anti-inflammatory activity.
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Affiliation(s)
- A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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22
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Zuccarella-Hackl C, Jimenez-Gonzalo L, von Känel R, Princip M, Jellestad L, Langraf-Meister RE, Znoj H, Schmid JP, Barth J, Schnyder U, Ledermann K. Positive psychosocial factors and the development of symptoms of depression and posttraumatic stress symptoms following acute myocardial infarction. Front Psychol 2023; 14:1302699. [PMID: 38111867 PMCID: PMC10725949 DOI: 10.3389/fpsyg.2023.1302699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Acute myocardial infarction (MI) is a potentially fatal condition, leading to high psychological distress and possibly resulting in the development of depressive symptoms and posttraumatic stress symptoms (PTSS). The aim of this study was to investigate the association of clusters of positive psychosocial factors (resilience, task-oriented coping, positive affect and social support) with both MI-induced depressive symptoms and PTSS, independent of demographic factors. Methods We investigated 154 consecutive patients with MI, 3 and 12 months after hospital discharge. All patients completed the short version of the German Resilience Scale, the Coping Inventory for Stressful Situations (CISS), the Enriched Social Support Inventory (ESSI) and the Global Mood Scale (GMS). The level of interviewer-rated MI-induced posttraumatic stress disorder (PTSD) symptoms at 3- and 12-months follow-up was evaluated through the Clinician-Administered PTSD Scale (CAPS). Depressive symptoms were assessed at 3- and 12-month follow-up with the Beck Depression Inventory (BDI-II). Results Three different clusters were revealed: (1) lonely cluster: lowest social support, resilience and average task-oriented coping and positive affect; (2) low risk cluster: highest resilience, task-oriented coping, positive affect and social support; (3) avoidant cluster: lowest task-oriented coping, positive affect, average resilience and social support. The clusters differed in depressive symptoms at 3 months (F = 5.10; p < 0.01) and 12 months follow-up (F = 7.56; p < 0.01). Cluster differences in PTSS were significant at 3 months (F = 4.78, p < 0.05) and 12 months (F = 5.57, p < 0.01) follow-up. Differences in PTSS subscales were found for avoidance (F = 4.8, p < 0.05) and hyperarousal (F = 5.63, p < 0.05), but not re-experiencing, at 3 months follow-up. At 12 months follow-up, cluster differences were significant for re-experiencing (F = 6.44, p < 0.01) and avoidance (F = 4.02, p < 0.05) but not hyperarousal. Discussion The present study contributes to a better understanding of the relationships among different positive psychosocial factors, depressive symptoms and PTSS following acute MI. Future interventions may benefit from taking into account positive psychosocial factors to potentially reduce patients' depressive symptoms and PTSS after MI.
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Affiliation(s)
- Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lucia Jimenez-Gonzalo
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Rey Juan Carlos of Madrid, Madrid, Spain
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic 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
| | - Lena Jellestad
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rebecca E. Langraf-Meister
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | | | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
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23
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Dyab R, Zuccarella-Hackl C, Princip M, Sivakumar S, Meister-Langraf RE, Znoj H, Schmid JP, Barth J, Schnyder U, von Känel R, Gidron Y. Role of Heart Rate Variability in the Association between Myocardial Infarction Severity and Post-Myocardial Infarction Distress. Life (Basel) 2023; 13:2266. [PMID: 38137867 PMCID: PMC10744743 DOI: 10.3390/life13122266] [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: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Myocardial infarction (MI) results in mental health consequences, including depression and post-traumatic stress disorder (PTSD). The risk and protective factors of such mental consequences are not fully understood. This study examined the relation between MI severity and future mental health consequences and the moderating role of vagal nerve activity. METHODS In a reanalysis of data from the Myocardial Infarction-Stress Prevention Intervention (MI-SPRINT) study, 154 post-MI patients participated. MI severity was measured by the Killip Scale and by troponin levels. Depression and PTSD symptoms were assessed with valid questionnaires, both at 3 and 12 months. Vagal nerve activity was indexed by the heart rate variability (HRV) parameter of the root-mean square of successive R-R differences (RMSSD). Following multivariate analyses, the association between MI severity and distress was examined in patients with low and high HRV (RMSSD = 30 ms). RESULTS In the full sample, the Killip index predicted post-MI distress only at 3 months, while troponin predicted distress at 3- and 12-months post-MI. However, HRV moderated the effects of the Killip classification; Killip significantly predicted symptoms of depression and PTSD at 3- and 12-months post-MI, but only in patients with low HRV. Such moderation was absent for troponin. CONCLUSION MI severity (Killip classification) predicted post-MI depression and PTSD symptoms, but only in patients with low HRV, suggesting that the vagal nerve is a partial protective (moderating) factor in the relation between Killip score and post-MI distress.
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Affiliation(s)
- Reham Dyab
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
- Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Sinthujan Sivakumar
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
- Clienia Schlössli AG, 8618 Oetwil am See, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012 Bern, Switzerland;
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, 9056 Gais, Switzerland;
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zürich, University of Zürich, 8006 Zurich, Switzerland;
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (C.Z.-H.); (M.P.); (S.S.); (R.E.M.-L.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8006 Zurich, Switzerland;
| | - Yori Gidron
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, The University of Haifa, Haifa 3498838, Israel
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24
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Khan N, Iqra Tanveer Khan S, Joti S, Malik J, Faraz M, Ashraf A. Association of Cardiovascular Diseases With Post-Traumatic Stress Disorder: An Updated Review. Cardiol Rev 2023:00045415-990000000-00174. [PMID: 37966219 DOI: 10.1097/crd.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The intricate relationship between post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD) has garnered increasing attention due to its bidirectional impact and potential for significant health consequences. Epidemiological evidence suggests that PTSD may serve as a risk factor for incident CVD, while acute CVD events can trigger PTSD, subsequently increasing the risk of recurrent cardiovascular events. This dynamic interplay is characterized by the human stress response, disrupted behavioral and lifestyle factors, and potential physiological mechanisms. Notably, the immediate aftermath of a cardiovascular event presents a critical window for intervention, offering the possibility of preventing the development of PTSD and its associated physiological and behavioral sequelae. However, while candidate mechanisms linking PTSD and CVD have been identified, determining which mechanisms are most amenable to intervention remains a challenge. This article emphasizes the urgency of addressing key unanswered questions in this domain. Despite an evolving understanding of the association between PTSD and CVD, causal relationships remain to be firmly established. Comprehensive investigations into the intricate interplay of behavioral and biological mechanisms are essential for identifying precise targets for intervention. Innovations in research methodologies, including the exploration of PTSD symptom dynamics and their impact on cardiovascular function, hold the potential for identifying crucial intervention points. Drawing parallels from prior challenges in translating identified risk factors into effective interventions, the field must prioritize systematic investigations and early-phase intervention trials. By doing so, researchers and clinicians can potentially develop strategies to mitigate CVD risk in the context of PTSD and improve both cardiovascular and mental health outcomes.
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Affiliation(s)
- Naqeeb Khan
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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25
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Nesic M, Vogel J, Krüger JP, Wenzel W, Sahebi A, Rassaf T, Siebermair J, Wesemann U. Association between different dimensions of anger and symptoms of post-traumatic stress disorder in at-risk cardiovascular patients during the COVID-19 pandemic. Front Psychiatry 2023; 14:1228192. [PMID: 37829760 PMCID: PMC10565353 DOI: 10.3389/fpsyt.2023.1228192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The common connecting factor between PTSD and cardiovascular diseases lies in the disruption of the stress processing system. The COVID-19 pandemic has led to an increase in stress levels worldwide. Due to the life-threatening situation of affected risk patients, this also led to the accumulation of post-traumatic stress symptoms (PTSS). The influence of anger on cardiovascular diseases has hardly been investigated so far. The focus of this study is on anger regulation in cardiovascular risk patients. The COVID-19 pandemic is considered as an additional stressor in this study, but not as a separate entity. The hypothesis is that individuals with inward anger are more prone to post-traumatic stress disorder (PTSD). Methods As part of the routine examination, all patients who were hospitalized between January 1st, 2021 and May 31st, 2022 with high-risk cardiovascular diseases were included. A total of N = 153 (84.1%) subjects participated in the study. On admission, anger (STAXI-2) and PTSD (PCL-5) were assessed using questionnaires. The relationship between different domains of anger and PTSS was examined. Results Inwardly directed anger was more pronounced in this population than in a standard sample (+1 SD) and had a significant impact on the presence of PTSD (B = -0.72, p < 0.001). Additionally, correlations were found between inward-directed anger and PTSD, as well as all other anger expressions studied and the PTSD total score. Discussion It can be assumed that anger and its regulation are relevant factors for both cardiac diseases and PTSD. The study results can be used for prevention, rehabilitation and therapeutic measures. However, the impact of inner anger on PTSD is theoretical and based on statistical testing. A confirmatory longitudinal study is needed to substantiate these results.
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Affiliation(s)
- Mihailo Nesic
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Julia Vogel
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisberg, Germany
| | | | - Werner Wenzel
- Department of Microbiology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Ali Sahebi
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisberg, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisberg, Germany
- Department of Cardiology, Krankenhaus Göttlicher Heiland GmbH, Vienna, Austria
| | - Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
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26
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Freiberger A, Richter C, Huber M, Beckmann J, Freilinger S, Kaemmerer H, Ewert P, Kohls N, Henningsen P, Allwang C, Andonian-Dierks C. Post-Traumatic Distress in Adults With Congenital Heart Disease: an Under-Recognized Complication? Am J Cardiol 2023; 203:9-16. [PMID: 37478638 DOI: 10.1016/j.amjcard.2023.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
The stressful and potentially traumatic perception of repeated hospitalization, outpatient check-ups, and medical interventions places a high stress burden on patients with congenital heart disease (CHD). These experiences can lead to post-traumatic stress symptoms (PTSSs). This study aimed to estimate the prevalence of PTSSs in adults with CHD (ACHDs) and to identify the associated risk factors. In this cross-sectional study, 234 ACHDs were recruited from November 2021 to August 2022 at a dedicated tertiary care center. Data were collected on general health, anxiety and depression, PTSSs, and on quality of life using validated and standardized questionnaires. In addition, the reasons for PTSSs were assessed using free-text responses. Overall, 17.1% to 20.5% (mean age: 35.2 ± 10.8 [18 to 66] years, 46.6% women) of the enrolled patients met the criteria for clinically relevant PTSSs related to their CHD or treatment. The associated risk factors (p <0.05) included preexisting mental distress (odds ratio [OR] 4.86), depression (OR 5.565) and anxiety (OR 3.36,), level of perceived mental distress during the traumatic event (OR 1.46), and number of medical procedures (OR 1.17). In addition, a worse clinical state was associated with more PTSSs (p = 0.018). Using free-text responses, the various reasons for PTSSs were identified, ranging from cardiac procedures to social stigma. In conclusion, the high prevalence of PTSSs calls for increased awareness of PTSSs in ACHDs in cardiovascular care. PTSSs and their associated disorder can adversely affect the manifestation and progression of cardiac disease. Thus, it is necessary to reflect upon psychocardiac prevention and intervention as an integral part of multidisciplinary cardiac care.
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Affiliation(s)
- Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
| | - Cristina Richter
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Niko Kohls
- Division of Health Promotion, Department of Social Work and Health, University of Applied Sciences Coburg, Coburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Caroline Andonian-Dierks
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
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Sopek Merkaš I, Lakušić N, Sonicki Z, Koret B, Vuk Pisk S, Filipčić I. Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation. World J Psychiatry 2023; 13:376-385. [PMID: 37383282 PMCID: PMC10294131 DOI: 10.5498/wjp.v13.i6.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome (ACS) have an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing worse survival outcomes than those who do not develop PTSD. Nevertheless, the prevalence rates of PTSD following ACS vary widely across studies, and it is noteworthy that in most cases, the diagnosis of PTSD was based on self-report symptom questionnaires, rather than being established by psychiatrists. Additionally, the individual characteristics of patients who develop PTSD after ACS can differ widely, making it difficult to identify any consistent patterns or predictors of the disorder.
AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation (CR) after ACS, as well as their characteristics in comparison to a control group.
METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia, the Special Hospital for Medical Rehabilitation Krapinske Toplice. Patient recruitment for the study took place over the course of one year, from January 1, 2022, to December 31, 2022, with a total of 504 participants. The expected average follow-up period for patients included in the study is about 18 mo, and currently ongoing. Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview, a group of patients with a PTSD diagnosis was identified. From the participants who do not have a PTSD diagnosis, patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.
RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study. Three patients declined to participate in the study. The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients. Out of the total sample of 504 patients, 74.2% were men (n = 374) and 25.8% were women (n = 130). The mean age of all participants was 56.7 years (55.8 for men and 59.1 for women). Among the 504 participants who completed the screening questionnaire, 80 met the cutoff criteria for the PTSD and qualified for further evaluation (15.9%). All 80 patients agreed to a psychiatric interview. Among them, 51 patients (10.1%) were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria. Among the variables analyzed, there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups. Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group (P = 0.035).
CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment. Furthermore, the data suggest that these patients may exhibit reduced physical activity levels, which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population. Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Zdenko Sonicki
- Department of Medical Statistics, Epidemiology, and Medical Informatics, School of Public Health Andrija Stampar, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Barbara Koret
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
| | - Sandra Vuk Pisk
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
- Department of Psychiatry and Neurology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Igor Filipčić
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
- Department of Psychiatry and Neurology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Psychiatry and Psychological Medicine, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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28
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Ghezzi ES, Sharman RLS, Selvanayagam JB, Psaltis PJ, Sanders P, Astley JM, Knayfati S, Batra V, Keage HAD. Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients. Europace 2023; 25:euad130. [PMID: 37311667 PMCID: PMC10264222 DOI: 10.1093/europace/euad130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. METHODS Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. RESULTS Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges' g = 0.07 (95%CI 0-0.14)]. CONCLUSION Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Rhianna L S Sharman
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5001, Australia
- Department of Medicine, School of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
| | - Peter J Psaltis
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Prashanthan Sanders
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Jack M Astley
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Sara Knayfati
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Vrinda Batra
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
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Cornelius T, Casey JA, Just AC, Rowland ST, Edmondson D. Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms. Front Psychol 2023; 14:1092106. [PMID: 37325741 PMCID: PMC10267367 DOI: 10.3389/fpsyg.2023.1092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population. Methods Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES. Results No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS. Conclusion Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sebastian T. Rowland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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Arabadjian M, Duberstein ZT, Sperber SH, Kaur K, Kalinowski J, Xia Y, Hausvater A, O'Hare O, Smilowitz NR, Dickson VV, Zhong H, Berger JS, Hochman JS, Reynolds HR, Spruill TM. Role of Resilience in the Psychological Recovery of Women With Acute Myocardial Infarction. J Am Heart Assoc 2023; 12:e027092. [PMID: 37026542 PMCID: PMC10227277 DOI: 10.1161/jaha.122.027092] [Citation(s) in RCA: 1] [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] [Received: 08/31/2022] [Accepted: 02/06/2023] [Indexed: 04/08/2023]
Abstract
Background Psychological well-being is important among individuals with myocardial infarction (MI) given the clear links between stress, depression, and adverse cardiovascular outcomes. Stress and depressive disorders are more prevalent in women than men after MI. Resilience may protect against stress and depressive disorders after a traumatic event. Longitudinal data are lacking in populations post MI. We examined the role of resilience in the psychological recovery of women post MI, over time. Methods and Results We analyzed a sample from a longitudinal observational multicenter study (United States, Canada) of women post MI, between 2016 and 2020. Perceived stress (Perceived Stress Scale-4 [PSS-4]) and depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]) were assessed at baseline (time of MI) and 2 months post MI. Demographics, clinical characteristics, and resilience (Brief Resilience Scale [BRS]) were collected at baseline. Low and normal/high resilience groups were established as per published cutoffs (BRS scores <3 or ≥3). Mixed-effects modeling was used to examine associations between resilience and psychological recovery over 2 months. The sample included 449 women, mean (SD) age, 62.2 (13.2) years, of whom 61.1% identified as non-Hispanic White, 18.5% as non-Hispanic Black, and 15.4% as Hispanic/Latina. Twenty-three percent had low resilience. The low resilience group had significantly higher PSS-4 and PHQ-2 scores than the normal/high resilience group at all time points. In adjusted models, both groups showed a decrease in PSS-4 scores over time. Conclusions In a diverse cohort of women post MI, higher resilience is associated with better psychological recovery over time. Future work should focus on developing strategies to strengthen resilience and improve psychological well-being for women with MI. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02905357; Unique identifier: NCT02905357.
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Affiliation(s)
- Milla Arabadjian
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Center for Population and Health Services ResearchNYU Long Island School of MedicineMineolaNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Zoe T. Duberstein
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Sarah H. Sperber
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Kiranjot Kaur
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Jolaade Kalinowski
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Human Development and Family SciencesUniversity of ConnecticutStamfordCT
| | - Yuhe Xia
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Anaïs Hausvater
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Olivia O'Hare
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- NYU Rory Meyers College of NursingNew YorkNY
| | - Nathaniel R. Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Victoria Vaughan Dickson
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- NYU Rory Meyers College of NursingNew YorkNY
| | - Hua Zhong
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Jeffrey S. Berger
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Judith S. Hochman
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Harmony R. Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Tanya M. Spruill
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
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Cunningham SC, Keleman A, Brandon R, Groninger H, BrintzenhofeSzoc K. Cardiac Related Psychosocial Distress and Traumatic Distress in Individuals with Advanced Heart Failure. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023:1-15. [PMID: 37029906 DOI: 10.1080/15524256.2023.2198158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Guided by the Transactional Model of Stress and Coping, this study explored relationships between cardiac related psychosocial distress, traumatic distress, and the number of lifetime traumas in people with advanced heart failure. Utilizing a cross-sectional survey design, a convenience sample of participants with advanced heart failure who received treatment in Washington, DC, completed standardized measures. Bivariate analysis showed a statistically significant difference in mean number of exposures and distress associated with advanced heart failure therapies and linear relationships between exposures and traumatic distress, distress and traumatic distress, and exposures and distress, as well as between the number of exposures and distress and traumatic distress and between the distress and traumatic distress. Multivariate analysis suggested that the higher the number of reported traumatic events, the higher the distress, and the higher the distress, the higher the traumatic distress. Social workers and allied team members should consider how a patient's distress relates to traumatic distress in the advanced stage heart failure population.
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Affiliation(s)
| | - Anne Keleman
- MedStar Washington Hospital Center, Washington, DC, USA
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Bremner JD, Piccinelli M, Garcia EV, Moncayo VM, Elon L, Nye JA, Cooke CD, Washington BP, Ortega RA, Desai SR, Okoh AK, Cheung B, Soyebo BO, Shallenberger LH, Raggi P, Shah AJ, Daaboul O, Jajeh MN, Ziegler C, Driggers EG, Murrah N, De Cecco CN, van Assen M, Krafty RT, Quyyumi AA, Vaccarino V. A Pilot Study of Neurobiological Mechanisms of Stress and Cardiovascular Risk. MEDICAL RESEARCH ARCHIVES 2023; 11:3787. [PMID: 37484871 PMCID: PMC10361343 DOI: 10.18103/mra.v11i4.3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective Coronary heart disease is a leading cause of death and disability. Although psychological stress has been identified as an important potential contributor, mechanisms by which stress increases risk of heart disease and mortality are not fully understood. The purpose of this study was to assess mechanisms by which stress acts through the brain and heart to confer increased CHD risk. Methods Coronary Heart Disease patients (N=10) underwent cardiac imaging with [Tc-99m] sestamibi single photon emission tomography at rest and during a public speaking mental stress task. Patients returned for a second day and underwent positron emission tomography imaging of the brain, heart, bone marrow, aorta (indicating inflammation) and subcutaneous adipose tissue, after injection of [18F]2-fluoro-2-deoxyglucose for assessment of glucose uptake followed mental stress. Patients with (N=4) and without (N=6) mental stress-induced myocardial ischemia were compared for glucose uptake in brain, heart, adipose tissue and aorta with mental stress. Results Patients with mental stress-induced ischemia showed a pattern of increased uptake in the heart, medial prefrontal cortex, and adipose tissue with stress. In the heart disease group as a whole, activity increase with stress in the medial prefrontal brain and amygdala correlated with stress-induced increases in spleen (r=0.69, p=0.038; and r=0.69, p=0.04 respectfully). Stress-induced frontal lobe increased uptake correlated with stress-induced aorta uptake (r=0.71, p=0.016). Activity in insula and medial prefrontal cortex was correlated with post-stress activity in bone marrow and adipose tissue. Activity in other brain areas not implicated in stress did not show similar correlations. Increases in medial prefrontal activity with stress correlated with increased cardiac glucose uptake with stress, suggestive of myocardial ischemia (r=0.85, p=0.004). Conclusions These findings suggest a link between brain response to stress in key areas mediating emotion and peripheral organs involved in inflammation and hematopoietic activity, as well as myocardial ischemia, in Coronary Heart Disease patients.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Marina Piccinelli
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ernest V. Garcia
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Valeria M. Moncayo
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lisa Elon
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Jonathon A. Nye
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - C. David Cooke
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Brianna P. Washington
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Rebeca Alvarado Ortega
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Shivang R. Desai
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Alexis K. Okoh
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Brian Cheung
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Britt O. Soyebo
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amit J. Shah
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Obada Daaboul
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Carrie Ziegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Nancy Murrah
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Carlo N. De Cecco
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Marly van Assen
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Robert T. Krafty
- Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed A. Quyyumi
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Lunkenheimer F, Eckert AJ, Hilgard D, Köth D, Kulzer B, Lück U, Lüdecke B, Müller A, Baumeister H, Holl RW. Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Sci Rep 2023; 13:1556. [PMID: 36707607 PMCID: PMC9883226 DOI: 10.1038/s41598-023-28373-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Mental comorbidities in patients with type 1 diabetes mellitus (T1D) are common, and can have a negative impact on acute blood glucose levels and long-term metabolic control. Information on the association of T1D and comorbid posttraumatic stress disorder (PTSD) with diabetes-related outcomes is limited. The aim was to examine the associations between a clinical diagnosis of PTSD and diabetes-related outcomes in patients with T1D. Patients with T1D and comorbid documented PTSD from the DPV database (n = 179) were compared to a group with T1D without PTSD (n = 895), and compared to a group with T1D without comorbid mental disorder (n = 895) by matching demographics (age, gender, duration of diabetes, therapy and migration background) 1:5. Clinical diabetes-related outcomes {body mass index (BMI), hemoglobin A1c (hbA1c), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycemia, number of hospital admissions, number of hospital days} were analyzed, stratified by age groups (≤ 25 years vs. > 25 years). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD or patients without mental disorders had significantly higher HbA1c (8.71 vs. 8.30 or 8.24%), higher number of hospital admissions (0.94 vs. 0.44 or 0.32 per year) and higher rates of DKA (0.10 vs. 0.02 or 0.01 events/year). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD had significantly higher BMI (0.85 vs. 0.59) and longer hospital stays (15.89 vs.11.58 days) than patients without PTSD. Patients with PTSD > 25 years compared with patients without PTSD or without any mental comorbidities had significantly fewer hospital admissions (0.49 vs. 0.77 or 0.69), but a longer hospital length of stay (20.35 vs. 11.58 or 1.09 days). We found that PTSD in younger patients with T1D is significantly related to diabetes outcome. In adult patients with T1D, comorbid PTSD is associated with fewer, but longer hospitalizations. Awareness of PTSD in the care of patients with T1D should be raised and psychological intervention should be provided when necessary.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany.,German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
| | - Dörte Hilgard
- Pediatric Endocrinology and Diabetology, Primary Psychosomatic Care, Bahnhofstraße 54, Witten, Germany
| | - Daniel Köth
- Department of Endocrinology and Diabetology, Hospital Sachsenhausen, Schulstraße 31, Frankfurt, Germany
| | - Bernhard Kulzer
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany.,Research Institute of the Diabetes-Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, Bad Mergentheim, Germany
| | - Ursula Lück
- Department of Pediatrics and Adolescent Medicine, Regional Hospital Mödling, Sr. M. Restituta-Gasse 12, Mödling, Austria
| | - Blanca Lüdecke
- Diabetes Centre, Alexianer St. Hedwig Hospital, Große Hambuger Straße 5-11, Berlin, Germany
| | - Antonia Müller
- Clinic Group Dr. Guth GmbH & Co. KG, Clinical Center Karlsburg, Greifswalder Straße 11, Karlsburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany.,German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
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Coping Strategies and Posttraumatic Growth Following Transient Ischemic Attack: A Qualitative Study. J Clin Med 2023; 12:jcm12020575. [PMID: 36675504 PMCID: PMC9863589 DOI: 10.3390/jcm12020575] [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: 11/16/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
A transient ischemic attack (TIA) is defined as a temporary neurological dysfunction due to focal brain ischemia. We aimed to identify common coping strategies and the possible occurrence of posttraumatic growth in TIA patients. Semistructured interviews were conducted with TIA patients three months after TIA. We asked the participants about possible changes in the aftermath of their TIA and their way of coping with said changes. All interviews were tape-recorded and subsequently transcribed verbatim. Thematic content analysis was performed to identify main categories and themes. Seventeen patients with a median age of 66 years completed the semistructured interviews. Qualitative content analysis revealed 332 single codes, from which the three main categories "impairments as a consequence of TIA", "coping strategies" and "posttraumatic growth" were generated. The main categories were further subdivided into seven categories and thirty-six themes. TIA patients may suffer from various physical impairments, which also involve medication side effects. Activating resources on the one hand, and avoiding negative thoughts and feelings on the other hand, were identified to be the relevant coping strategies in TIA patients. Posttraumatic growth seems to be a common phenomenon after TIA, which may have important implications for treatment and rehabilitation.
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Lunkenheimer F, Garatva P, Steubl L, Baumeister H. Prevalence and incidence of post-traumatic stress disorder and symptoms in people with chronic somatic diseases: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1107144. [PMID: 36741119 PMCID: PMC9889922 DOI: 10.3389/fpsyt.2023.1107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Comprehensive evidence on prevalence and incidence of post-traumatic stress disorder (PTSD) and symptoms (PTSS) in people with chronic somatic diseases (CD) is lacking. OBJECTIVE To systematically and meta-analytically examine prevalence and incidence of PTSD and PTSS in people with CD compared with people without CD. METHODS MEDLINE, Embase, and PsycINFO were searched from inception (1946) to June 2020. Studies reporting point, 12-month, lifetime prevalence, or 12-month incidence of PTSD and PTSS in people with CD were selected and reviewed in accordance with PRISMA guidelines by two independent reviewers. Risk of bias was assessed by a combination of the Newcastle-Ottawa Scale and recommendations of the Cochrane Collaboration for non-comparative studies. Pooled estimates were calculated using random effects meta-analyses. Between-study heterogeneity was assessed using the I2 statistic. RESULTS Data were extracted from studies reporting on point prevalence (k = 60; n = 21,213), 12-month prevalence (k = 3; n = 913), and lifetime prevalence (k = 6; n = 826). 12-month incidence estimates were not available. The pooled estimate for the point prevalence of PTSD (k = 41) across CD was 12.7% (95% CI, 8.6 to 18.4%) and 19.6% regarding PTSS (13.2 to 28.1%; k = 24). Individuals with cerebrovascular disorder (k = 4) showed the highest pooled point prevalence for PTSD (23.6%, 95% CI, 16.8 to 32.0%), those with cardiovascular diseases the lowest (6.6%, 1.9 to 20.9%; k = 5). The pooled 12-month prevalence of PTSD (k = 3) was 8.8% (95% CI, 5.5 to 13.5%) and the lifetime prevalence (k = 6) was 12.1% (7.6 to 18.5%). Pooled estimates of PTSD prevalence in people with compared to those without CD showed an odds ratio of 9.96 (95% CI, 2.55 to 38.94; k = 5). CONCLUSION Post-traumatic stress disorder and PTSS are common and substantially higher in people with compared to those without CD. Earlier detection and treatment of this comorbidity might improve mental and physical health, reduce the incidence of further diseases, and reduce mortality. CLINICAL TRIAL REGISTRATION https://osf.io/9xvgz, identifier 9xvgz.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Patricia Garatva
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Predictors of mental health symptomatology among Kurdish patients who recovered from COVID-19 in Iraq. DISCOVER PSYCHOLOGY 2022. [PMCID: PMC9244450 DOI: 10.1007/s44202-022-00043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
While a growing body of research has documented severe psychosocial consequences of the new Coronavirus disease (COVID-19) for the affected people, research mainly focused either on health care workers or the general population. There is a dearth of scientific research on the mental health status of recovered patients, especially in low- and middle-income countries. The purpose of the current study was to determine the mental health symptomatology and its associated factors among Iraqis who recovered from COVID-19. Participants were Iraqi Kurdish individuals who had previously been diagnosed with COVID-19 during the first wave of COVID-19, and they were recruited based on lists of recovered patients provided by from public health institutions. Using standardized demographic and mental health questionnaires, structured telephone interviews with 57 recovered patients were contacted. It was found that 31.6% of the participating recovered patients with COVID-19 met the diagnostic criteria for post-traumatic stress disorder (PTSD), and 21.05% were classified with probable depression. Hospitalized survivors had higher PTSD and depression symptoms than those not hospitalized. We also found that higher levels of PTSD and depression symptoms were predicted by younger age, hospitalization due to COVID-19, and having a family member who died from COVID-19. In the context of the global COVID-19 pandemic, psychological and psychiatric treatment may be particularly relevant for younger adult patients and those with more severe COVID-19 symptoms who experienced hospitalized care.
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Hargrave AS, Sumner JA, Ebrahimi R, Cohen BE. Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care. Curr Cardiol Rep 2022; 24:2067-2079. [PMID: 36306020 DOI: 10.1007/s11886-022-01809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Posttraumatic stress disorder (PTSD) may be an important risk factor for cardiovascular disease (CVD). We explore the literature linking PTSD to CVD, potential mechanisms, interventions, and clinical implications. We outline gaps in current literature and highlight necessary future research. RECENT FINDINGS PTSD has been independently associated with deleterious effects on cardiovascular health through biological, behavioral, and societal pathways. There are evidence-based psychotherapeutic interventions and pharmacotherapies for PTSD that may mitigate its impact on CVD. However, there are limited studies that rigorously analyze the impact of treating PTSD on cardiovascular outcomes. Trauma-informed CVD risk stratification, education, and treatment offer opportunities to improve patient care. These approaches can include a brief validated screening tool for PTSD identification and treatment. Pragmatic trials are needed to test PTSD interventions among people with CVD and evaluate for improved outcomes.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA. .,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA.
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1563, USA
| | - Ramin Ebrahimi
- Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA.,Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA
| | - Beth E Cohen
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA.,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA
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Meinhausen C, Prather AA, Sumner JA. Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review. Health Psychol 2022; 41:663-673. [PMID: 35007121 PMCID: PMC9271141 DOI: 10.1037/hea0001143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Growing longitudinal research has demonstrated that posttraumatic stress disorder (PTSD) precedes and predicts the onset of cardiovascular disease (CVD), and a number of physiological (e.g., dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, chronic systemic inflammation) and behavioral (e.g., physical inactivity, smoking, poor diet) factors might underlie this association. In this narrative review, we focus on sleep as a modifiable risk factor linking PTSD with CVD. METHOD We summarize the evidence for sleep disturbance after trauma exposure and the potential cardiotoxic effects of poor sleep, with an emphasis on mechanisms. In addition, we review the literature that has examined sleep in the context of the PTSD-CVD risk relation. RESULTS Although sleep disturbance is a hallmark symptom of PTSD and a well-established risk factor for the development of CVD, the role of sleep in the association between PTSD and CVD has been largely unexamined in the extant literature. However, such work has the potential to improve our understanding of mechanisms of risk and inform intervention efforts to offset elevated CVD risk after trauma. CONCLUSIONS We outline several recommendations for future research and behavioral medicine models in order to help define and address the role of sleep behavior in the development of CVD among trauma-exposed individuals with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Seligowski AV, Webber TK, Marvar PJ, Ressler KJ, Philip NS. Involvement of the brain-heart axis in the link between PTSD and cardiovascular disease. Depress Anxiety 2022; 39:663-674. [PMID: 35708302 PMCID: PMC9588548 DOI: 10.1002/da.23271] [Citation(s) in RCA: 3] [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] [Received: 12/08/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain-heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD-CVD link. The brain-heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain-heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain-heart axis. Finally, we discuss sex considerations in the PTSD-CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain-heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | | | | | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, of Brown University, Providence, RI, USA
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40
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Agarwal S, Birk JL, Abukhadra SL, Rojas DA, Cornelius TM, Bergman M, Chang BP, Edmondson DE, Kronish IM. Psychological Distress After Sudden Cardiac Arrest and Its Impact on Recovery. Curr Cardiol Rep 2022; 24:1351-1360. [PMID: 35921024 PMCID: PMC9561080 DOI: 10.1007/s11886-022-01747-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the prevalence, correlates, and health consequences of poor mental health in the increasingly sizable population of survivors of Sudden cardiac arrest (CA) and to describe current intervention research in this area. RECENT FINDINGS After CA many patients report high psychological distress, including depression, generalized anxiety, and posttraumatic stress. Emerging evidence suggests that distressed patients' attention may narrow such that anxious awareness of afferent cardiac signals e.g., changes in heart rate or blood pressure, becomes predominant and a cause for concerned, constant monitoring. This cardiac-specific anxiety followed by behavioral avoidance and physiological hyperreactivity may increase patients' already high risk of secondary cardiovascular disease and undermine their health-related quality of life (HRQoL). Unlike other cardiovascular diseases, no clinical practice guidelines exist for assessing or treating psychological sequelae of CA. Future research should identify modifiable psychological targets to reduce secondary cardiovascular disease risk and improve HRQoL.
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Affiliation(s)
- Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA.
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Sabine L Abukhadra
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Danielle A Rojas
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Talea M Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Maja Bergman
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, USA
| | - Donald E Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
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The role of sense of coherence in reducing anxiety and depressive symptoms among patients at the first acute coronary event: A three-year longitudinal study. J Psychosom Res 2022; 160:110974. [PMID: 35763942 DOI: 10.1016/j.jpsychores.2022.110974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although several studies suggest an association between psychological distress and increased morbidity and mortality in various cardiac populations, little is known about positive psychological resources, like Sense of Coherence (SOC), that may reduce distress. This longitudinal observational study aimed to test the hypothesis that a strong SOC predicted a longitudinal decrease in anxiety and depression in a sample of patients after their first acute coronary event. METHODS A sample of 275 patients completed the Hospital Anxiety Depression Scale (HADS) and the SOC Scale at five time-points (at the baseline and after 6, 12, 24, and 36 months). Longitudinal trajectories of anxiety, depression, and SOC were examined through hierarchical (generalized) linear models, controlling for sociodemographic and clinical indicators. RESULTS 38.6% of patients experienced clinically relevant anxiety symptoms soon after the cardiovascular event, whereas only 20.8% experienced clinically relevant depressive symptoms. Anxiety symptoms decreased over time, plateaued, and then slightly increased, whereas depressive symptoms tended to be stable; these variables were positively associated during all time points. The SOC did not change over time; a strong SOC at baseline predicted decreased anxiety and depression. CONCLUSION Findings showed a strong relationship between SOC and symptoms of anxiety and depression, and they suggested the importance of a salutogenic approach in clinical practice and the relevance of interventions aimed at increasing resilience resources like the SOC in patients with cardiovascular diseases.
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Katrinli S, Oliveira NCS, Felger JC, Michopoulos V, Smith AK. The role of the immune system in posttraumatic stress disorder. Transl Psychiatry 2022; 12:313. [PMID: 35927237 PMCID: PMC9352784 DOI: 10.1038/s41398-022-02094-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) develops in a subset of individuals upon exposure to traumatic stress. In addition to well-defined psychological and behavioral symptoms, some individuals with PTSD also exhibit elevated concentrations of inflammatory markers, including C-reactive protein, interleukin-6, and tumor necrosis factor-α. Moreover, PTSD is often co-morbid with immune-related conditions, such as cardiometabolic and autoimmune disorders. Numerous factors, including lifetime trauma burden, biological sex, genetic background, metabolic conditions, and gut microbiota, may contribute to inflammation in PTSD. Importantly, inflammation can influence neural circuits and neurotransmitter signaling in regions of the brain relevant to fear, anxiety, and emotion regulation. Given the link between PTSD and the immune system, current studies are underway to evaluate the efficacy of anti-inflammatory treatments in those with PTSD. Understanding the complex interactions between PTSD and the immune system is essential for future discovery of diagnostic and therapeutic tools.
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Affiliation(s)
- Seyma Katrinli
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
| | - Nayara C. S. Oliveira
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,National Institute of Woman, Child, and Adolescence Health Fernandes Figueira, Rio de Janeiro, RJ Brazil ,grid.418068.30000 0001 0723 0931Department of Violence and Health Studies Jorge Careli, National School of Public Health, Fiocruz, Rio de Janeiro, RJ Brazil
| | - Jennifer C. Felger
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502The Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Vasiliki Michopoulos
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
| | - Alicia K. Smith
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
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Armand S, Wagner MK, Ozenne B, Verbunt J, Sep SJS, Berg SK, Knudsen GM, Stenbæk DS. Acute Traumatic Stress Screening Can Identify Patients and Their Partners at Risk for Posttraumatic Stress Disorder Symptoms After a Cardiac Arrest: A Multicenter Prospective Cohort Study. J Cardiovasc Nurs 2022; 37:394-401. [PMID: 37707973 DOI: 10.1097/jcn.0000000000000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is prevalent in patients who have had a cardiac arrest and their partners. Accordingly, acute traumatic stress screening is recommended, but its association with later PTSD symptoms has never been addressed in postresuscitation settings. OBJECTIVE The aim of this study was to examine whether acute traumatic stress is associated with PTSD symptoms in patients who have had a cardiac arrest and their partners. METHODS This multicenter longitudinal study of 141 patients and 97 partners measures acute traumatic stress at 3 weeks and PTSD symptoms at 3 months and 1 year after resuscitation, using the Impact of Event Scale. Linear regression models were used to evaluate the association between severity of acute traumatic stress and PTSD symptoms and post hoc to explore effects of group (patients/partners), age, and sex on acute traumatic stress severity. We categorized Impact of Event Scale scores higher than 26 at 3 months and 1 year as clinical severe PTSD symptoms . RESULTS Higher acute traumatic stress severity is significantly positively associated with higher PTSD symptom severity at 3 months (patients and partners: P < .001) and 1 year (patients and partners: P < .001) postresuscitation, with the strongest association for women compared with men ( P = .03). Acute traumatic stress was higher in women compared with men across groups ( P = .02). Clinical severe PTSD symptoms were present in 26% to 28% of patients and 45% to 48% of partners. CONCLUSION Experiencing a cardiac arrest may elicit clinical severe PTSD symptoms in patients, but particularly in their partners. Screening patients and partners for acute traumatic stress postresuscitation is warranted to identify those at increased risk of long-term PTSD symptoms.
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Arieli M, Kizony R, Gil E, Agmon M. Participation in daily activities after acute illness hospitalization among high-functioning older adults: a qualitative study. J Clin Nurs 2022. [PMID: 35733321 DOI: 10.1111/jocn.16418] [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: 03/31/2022] [Revised: 05/22/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe high-functioning older adults' experiences of participation in daily activities and perceived barriers and facilitators to participation one- and 3-months post-acute hospitalization. BACKGROUND Older adults discharged after acute illness hospitalization are at risk for functional decline and adverse health outcomes. Yet, little is known about the subjective experience of resuming participation in meaningful activities beyond the immediate post-discharge period among high-functioning older adults, a mostly overlooked sub-sample. DESIGN Qualitative descriptive longitudinal study adhering to the COREQ guidelines. METHODS Forty two participants ages ≥65 years (mean age 75, SD ± 7.9) were recruited from internal medicine wards. Semi-structured interviews were conducted at participants' homes one-month post-discharge, followed by a telephone interview 3-months after. Data were analyzed using thematic analysis. RESULTS Participants perceived the hospitalization as a disruption of healthy and meaningful routines. This first key theme had unique expressions over time and included two sub-themes. At one month: (1) reduced life spaces and sedentary routines. At 3 months: (2) a matter of quality not quantity - giving up even one meaningful activity can make a difference. The second key theme was described as a combination of physical and psychological barriers to participation over time. These themes demonstrated the profound impact of the hospitalization on behavior (participation) and feelings (e.g., symptoms). The third key theme was described as a dyad of intrinsic and extrinsic facilitators to participation. CONCLUSIONS Acute illness hospitalization may lead to subtle decreases in participation in meaningful health-promoting activities, even among high-functioning older adults. These changes may impact overall well-being and possibly mark the beginning of functional decline. RELEVANCE TO CLINICAL PRACTICE This study highlights the need for a more comprehensive assessment of participation, relevant for high-functioning older adults, to enable person-centered care. Intervention programs should address the modifiable barriers and facilitators identified in this study.
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Affiliation(s)
- Maya Arieli
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel.,Department of Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel
| | - Efrat Gil
- Geriatric Unit, Clalit Health Services, Haifa and West Galilee, Galilee, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
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Mental Stress and Cardiovascular Health-Part I. J Clin Med 2022; 11:jcm11123353. [PMID: 35743423 PMCID: PMC9225328 DOI: 10.3390/jcm11123353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022] Open
Abstract
Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.
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Smith TW. Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management. Curr Cardiol Rep 2022; 24:761-774. [PMID: 35380384 PMCID: PMC8981884 DOI: 10.1007/s11886-022-01695-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. RECENT FINDINGS Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.
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Affiliation(s)
- Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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Al Jowf GI, Ahmed ZT, An N, Reijnders RA, Ambrosino E, Rutten BPF, de Nijs L, Eijssen LMT. A Public Health Perspective of Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6474. [PMID: 35682057 PMCID: PMC9180718 DOI: 10.3390/ijerph19116474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.
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Affiliation(s)
- Ghazi I. Al Jowf
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ziyad T. Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairyah 52726, Saudi Arabia;
| | - Ning An
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Rick A. Reijnders
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW (School for Oncology and Reproduction), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Laurence de Nijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lars M. T. Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Bioinformatics—BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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48
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Kovalsky D, Roberts MB, Freeze B, Moss J, Jones CW, Kilgannon H, Edmondson DE, Trzeciak S, Fuller BM, Roberts BW. Posttraumatic stress disorder symptoms after respiratory and cardiovascular emergencies predict risk of hospital readmission: A prospective cohort study. Acad Emerg Med 2022; 29:598-605. [PMID: 35064719 DOI: 10.1111/acem.14438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Twenty-five percent of patients presenting to the emergency department (ED) for a respiratory or cardiovascular medical emergency develop clinically significant posttraumatic stress disorder (PTSD) symptoms. It is possible that development of PTSD symptoms in this cohort is associated with subsequent adverse physical health events. Our objective was to test whether clinically significant PTSD symptoms 30 days postdischarge are associated with increased risk for hospital readmission within 24 months after discharge among patients presenting to the ED for a respiratory or cardiovascular emergency. METHODS This was a prospective cohort study conducted between January 1, 2018, and December 31, 2020, at a U.S. academic medical center, including adult patients presenting with acute respiratory failure or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. PTSD symptoms 30 days postdischarge were measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5. The primary outcome was all-cause hospital readmission over the subsequent 24 months after hospital discharge from the index ED visit. RESULTS Of the 99 patients included, 73% (95% confidence interval [CI] = 63% to 81%) had a hospital readmission within 24 months. In a multivariable Cox proportional hazards model adjusting for potential confounders (e.g., age, severity of illness during index ED visit, preexisting comorbid conditions) presence of clinically significant PTSD symptoms at 30 days was independently associated with increased risk for all-cause hospital readmission at 24 months (hazards ratio = 2.19, 95% CI = 1.30 to 3.69). These results remained statistically significant across multiple sensitivity analyses. CONCLUSIONS Hospital readmission is common among survivors of acute respiratory failure and cardiovascular instability, and PTSD symptoms 30 days postdischarge are an independent predictor of hospital readmission. Survivors of medical emergencies may warrant follow-up evaluation for PTSD symptoms, and future research is warranted to better understand the relationship between psychological trauma and hospital readmission.
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Affiliation(s)
- Danielle Kovalsky
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Michael B. Roberts
- Institutional Research and Outcomes Assessment Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania USA
| | - Brian Freeze
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Jeena Moss
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Christopher W. Jones
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Hope Kilgannon
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Donald E. Edmondson
- Department of Medicine Columbia University Medical Center New York New York USA
| | - Stephen Trzeciak
- Department of Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
| | - Brian M. Fuller
- Department of Emergency Medicine Washington University School of Medicine St. Louis Missouri USA
- Department of Anesthesiology, Division of Critical Care Medicine Washington University School of Medicine St. Louis Missouri USA
| | - Brian W. Roberts
- Department of Emergency Medicine Cooper University Health Care, Cooper Medical School of Rowan University Camden New Jersey USA
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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.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *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
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50
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Gebhardt P, Caldarone F, Westhoff-Bleck M, Olsson KM, Hoeper MM, Park DH, Stapel B, Breitner MH, Werth O, Heitland I, Kahl KG. Metacognitive Short-Term Intervention in Patients With Mental Disorders Following Cardiovascular Events. Front Psychiatry 2022; 13:812807. [PMID: 35444582 PMCID: PMC9013742 DOI: 10.3389/fpsyt.2022.812807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental disorders are common among patients with severe cardiovascular diseases (CVD). Yet, there is a lack of easily accessible evidence-based treatments. Recent research indicates elevated prevalence of dysfunctional metacognitions in patients with mental disorders following cardiovascular events. As metacognitive therapy (MCT) is an established treatment to modify metacognitions, we tested if a brief metacognitive intervention via videotelephony is effective in this patient group. Methods A brief MCT treatment was tailored to CVD patients and designed as a face-to-face internet-based intervention. Five patients with CVDs and comorbid mental disorders underwent a psychocardiological examination and diagnostic approach. Each patient participated in eight 50 min sessions via encrypted video messenger service. Metacognitions, depression and anxiety symptoms and quality of life were assessed by self-report measures pre- and post-treatment. Patients rated dysfunctional thought processes, current psychological impairment, and treatment satisfaction after each session. Intended follow-up measures were not reported due to missing data. Results For most patients, the brief metacognitive intervention was associated with a decrease in dysfunctional metacognitions and a reduction of symptoms of anxiety and depression post-treatment. Psychological and physiological quality of life improved. Patients reported high satisfaction with the tailored treatment. Conclusion Our results suggest that a brief internet-based metacognitive treatment may be a promising tool for patients with CVDs and comorbid mental disorders. Feasibility and acceptance of the intervention was rated high by the patients. Further research is necessary to support the preliminary findings and to adapt and evaluate the intervention in a controlled clinical trial setting.
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Affiliation(s)
- Philippa Gebhardt
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Flora Caldarone
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Karen M. Olsson
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael H. Breitner
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Oliver Werth
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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