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Krawiec C, Cash M, Ceneviva G, Tian Z, Zhou S, Thomas NJ. Outcomes of critically ill children with pre-existing mental health conditions. Pediatr Investig 2024; 8:108-116. [PMID: 38910847 PMCID: PMC11193371 DOI: 10.1002/ped4.12422] [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] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/25/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Critically ill children with pre-existing mental health conditions may have an increased risk of poor health outcomes. Objective We aimed to evaluate if pre-existing mental health conditions in critically ill pediatric patients would be associated with worse clinical outcomes, compared to children with no documented mental health conditions. Methods This retrospective observational cohort study utilized the TriNetX electronic health record database of critically ill subjects aged 12-18 years. Data were analyzed for demographics, pre-existing conditions, diagnostic, medication, procedural codes, and mortality. Results From a dataset of 102 027 critically ill children, we analyzed 1999 subjects (284 [14.2%] with a pre-existing mental health condition and 1715 [85.8%] with no pre-existing mental health condition). Multivariable analysis demonstrated that death within one year was associated with the presence of pre-existing mental health conditions (odds ratio 8.97 [3.48-23.15], P < 0.001), even after controlling for the presence of a complex chronic condition. Interpretation The present study demonstrates that the presence of pre-existing mental health conditions was associated with higher odds of death within 1 year after receiving critical care. However, the confidence interval was wide and hence, the findings are inconclusive. Future studies with a larger sample size may be necessary to evaluate the true long-term impact of children with pre-existing mental health conditions who require critical care services.
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Affiliation(s)
- Conrad Krawiec
- Department of PediatricsPediatric Critical Care MedicinePenn State Hershey Children's HospitalPennsylvaniaUSA
| | - Morgan Cash
- Department of PediatricsPediatric Critical Care MedicinePenn State Hershey Children's HospitalPennsylvaniaUSA
| | - Gary Ceneviva
- Department of PediatricsPediatric Critical Care MedicinePenn State Hershey Children's HospitalPennsylvaniaUSA
| | - Zizhong Tian
- Department of Public Health SciencesDivision of Biostatistics and BioinformaticsPennsylvania State University College of MedicinePennsylvaniaUSA
| | - Shouhao Zhou
- Department of Public Health SciencesDivision of Biostatistics and BioinformaticsPennsylvania State University College of MedicinePennsylvaniaUSA
| | - Neal J. Thomas
- Department of PediatricsPediatric Critical Care MedicinePenn State Hershey Children's HospitalPennsylvaniaUSA
- Department of Public Health SciencesPennsylvania State University College of MedicinePennsylvaniaUSA
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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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Jesudason E. Consent with complications in mind. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109731. [PMID: 38253464 DOI: 10.1136/jme-2023-109731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
Parity of esteem describes an aspiration to see mental health valued as much as physical. Proponents point to poorer funding of mental health services, greater stigma and poorer physical health for those with mental illness. Stubborn persistence of such disparities suggests a need to do more than stipulate ethical and legal obligations toward justice or fairness. Here, I propose that we should rely more on our legal obligations toward informed consent. The latter requires clinicians to disclose information about risks in a way that is sufficient to satisfy what a prudent patient would reasonably want to understand in their circumstances. I argue that inadequate disclosure of the mental health complications of common surgeries risks exposing the craft specialists performing them to clinical negligence claims. Patients could argue they were counselled about said risks, improperly or not at all: improperly, if advised by a craft specialist lacking sufficient expertise in mental health; not at all, if mental health complications were simply forgotten. From this, I argue that a prudent approach for craft specialists would be to support and fund 'integrative' specialists (from rehabilitation medicine, liaison psychiatry and health psychology), more often to work alongside them within a multidisciplinary team that is better placed to navigate consent (via a prehabilitation process, for example). Based on duties toward consent, the extension of this type of coworking is another way to improve the resource and understanding accorded to mental health-but by starting within the citadels of physical health.
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Affiliation(s)
- Edwin Jesudason
- Rehabilitation Medicine, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
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van den Houdt SCM, Widdershoven J, Kupper N. Patient and healthcare professionals' perceived barriers and facilitators to the implementation of psychosocial screening in cardiac practice: A Delphi study. Gen Hosp Psychiatry 2023; 85:104-113. [PMID: 37862959 DOI: 10.1016/j.genhosppsych.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Psychosocial risk factors contribute to the incidence and progression of coronary heart disease (CHD). Psychosocial screening may identify individuals who are at risk and aid them with getting appropriate care. To successfully implement psychosocial screening in the cardiology practice, the current study aims to identify key barriers and facilitators to its implementation and evaluate their perceived importance among health care professionals (HCPs) and patients. METHODS We took a modified 3-round Delphi study approach to gain insight into key determinants that could either impede or ease implementation. Round 1 gathered data from HCPs (n = 9; cardiologists, medical psychologists, cardiac nurses) and CHD patients (n = 21), which we transcribed verbatim, coded, and processed into unique determinants. In rounds 2 and 3, participants were asked to select the most relevant determinants and rank them based on importance. Subsequently, determinants were classified by implementation level. RESULTS Patients were generally more positive towards screening. HCP barriers included time-constraints, disruption of primary activities, and limited knowledge on psychosocial risk and screening, while patient barriers were commonly related to accessibility and patient characteristics (e.g., health literacy, motivation). Facilitators of both groups mainly pertained to the use of the screener and follow-up care, such as increasing the accessibility and the benefits of the screener. CONCLUSION Barriers may be targeted by enhancing the effects of the facilitators. Increasing the accessibility to the screener and interventions, improving information provision, and appointing a contact person to oversee the screening process may ease the screening and care process for both patients and HCPs.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands
| | - Jos Widdershoven
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden hospital, the Netherlands
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands.
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Tomán E, Pintér JN, Hargitai R. The role of the lived body during the integration of the traumatic experience of the sternotomy scar: A case study. J Eval Clin Pract 2023. [PMID: 37723845 DOI: 10.1111/jep.13925] [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: 04/07/2023] [Revised: 08/07/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Open heart surgery is a potentially traumatic experience for patients, thus posing a real risk to both the patient's physical and mental health as well as bodily integrity. All of these can greatly affect the emotional relationship to the sternotomy scar, the physical aspect of self-representation. Sternotomy scars mark patients for life, yet our knowledge of patients' subjective experiences is unknown. METHOD In our case study, we explore the embodied experiences of a woman (42) who underwent open heart surgery with the method of interpretative phenomenological analysis combined with drawings. RESULTS The body and the bodily experiences play a prominent role in the formation, healing process, and symbolism of a scar. The central core of the traumatic experience of open heart surgery is the attack against the patient's sensation of bodily integrity. The interviewee experiences the surgery as abuse committed on her body, a memory that is deeply etched both in the physical memory and in the form of a scar on the skin. CONCLUSION Based on our study, it seems that the corporeal dimension of posttraumatic growth may develop after the traumatic experience of heart surgery, in which bodily intimacy with oneself and Significant Others plays a major role. In this case study, the objective reality of the heart as "sick" flesh and the "broken, pierced" bone (Körper), as well as the dissociation-and then its integration-of the lived, living body experience (Leib) are outlined. Our case study was analysed in the theoretical framework of phenomenology and psychoanalysis.
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Affiliation(s)
- Edina Tomán
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Counseling and School Psychology, Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Judit Nóra Pintér
- Department of Counseling and School Psychology, Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Rita Hargitai
- Department of Personality and Clinical PSychology, Institute of Psychology, PPKE Pázmány Péter Catholic University, Budapest, Hungary
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Kazlauskas E, Grazulyte D, Kvedaraite M, Jovaisiene I, Zelviene P, Sipylaite J. Can Cardiac Surgery Lead to ICD-11 PTSD and Complex PTSD? Findings of a 5-year Follow-up Study. Psychiatr Q 2023:10.1007/s11126-023-10023-0. [PMID: 37067614 DOI: 10.1007/s11126-023-10023-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/18/2023]
Abstract
Cardiac surgery may lead to various neuropsychiatric conditions, including posttraumatic stress disorder (PTSD). The 11th revision of the International Classification of Diseases (ICD-11) included a new complex posttraumatic stress disorder (CPTSD) disorder in addition to PTSD. This study aimed to explore whether cardiac surgery could be associated with PTSD and CPTSD at a five-year follow-up after cardiac surgery. The study sample comprised 210 patients (mean age 67, 69.5% male) who had undergone cardiac surgery. The self-report International Trauma Questionnaire (ITQ) was used to assess ICD-11 PTSD and CPTSD. The Medical Outcomes Study 36 Item Short Form Health Survey (SF-36) questionnaire was used to measure health-related quality of life (HRQOL). We found 5.2% of cardiac surgery-related probable PTSD and CPTSD at a 5-year follow-up, 1.9% PTSD, and 3.3% CPTSD. Low HRQOL was associated with a high risk for PTSD/CPTSD at follow-up. The results showed that cardiac surgery might have a long-term effect on PTSD and CPTSD symptoms. Patients with low HRQOL are at higher risk of having PTSD/CPTSD risk. The study informs about the need for psychosocial interventions to reduce the impact of cardiac surgery on neuropsychiatric conditions and the improvement of HRQOL.
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Affiliation(s)
- Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania.
| | - Daiva Grazulyte
- Clinic for Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Monika Kvedaraite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Ieva Jovaisiene
- Clinic for Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Jurate Sipylaite
- Clinic for Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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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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Eades ND, Kauffman BY, Bakhshaie J, Cardoso JB, Zvolensky MJ. Eating expectancies among trauma-exposed Latinx college students: The role of mindful attention. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:790-797. [PMID: 33830868 PMCID: PMC8809199 DOI: 10.1080/07448481.2021.1908304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/23/2020] [Accepted: 03/21/2021] [Indexed: 05/05/2023]
Abstract
Objective: Emergent research suggests that trauma-exposed Latinx college students are a particularly at-risk group for eating-related problems. For this reason, there is a need to further understand the cognitive processes that may underpin maladaptive eating among this vulnerable segment of the population. Participants: Participants included 304 trauma exposed Latinx college students (84.5% females; Mage = 22.8 years, SD = 5.79). Methods: The current study examined the role of mindful attention in relation to several distinct expectancies related to eating. Results: Results indicated that lower reported levels of mindful attention were associated with greater levels of expectancies of eating to help manage negative affect, expectancies that eating will alleviate boredom, and expectancies that eating will lead to feeling out of control. Conclusions: These findings suggest that it may be beneficial to assess for mindful attention among Latinx college students with a history of trauma exposure presenting with problematic eating behaviors.
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Affiliation(s)
- Natasha D. Eades
- Department of Psychology, University of Houston, Houston, United States
| | | | - Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, United States
| | - Jodi Berger Cardoso
- Graduate College of Social Work, University of Houston, Houston, United States
- Health Institute, University of Houston, Houston, Texas, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Health Institute, University of Houston, Houston, Texas, United States
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Khater WA, Alfarkh MA, Allnoubani A. The Association Between Vitamin D Level and Chest Pain, Anxiety, and Fatigue in Patients With Coronary Artery Disease. Clin Nurs Res 2023; 32:639-647. [PMID: 36205377 DOI: 10.1177/10547738221126325] [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: 11/16/2022]
Abstract
This study sought to assess the association between vitamin D deficiency (VDD) and chest pain, anxiety, and fatigue in patients with coronary artery disease (CAD). A cross-sectional study was conducted to collect data from a sample of 90 participants with CAD. Serum 25OHD3 was measured using a radioimmunoassay procedure. Chest pain was assessed using the Numeric Pain Rating Scale, anxiety using the Anxiety Subscale, and fatigue by the General Fatigue subscale. The majority of participants (80%) had VDD. Results showed that the level of vitamin D was significantly negatively associated with chest pain (r = -.43, p = .00); anxiety (r = -.466, p = .00); and fatigue (r = -.25, p = .018). Findings suggest the role of VDD in heightened central sensitivity in cardiac-related symptoms such as chest pain, anxiety, and fatigue. Patients with CAD should be monitored for VDD so that the condition can be corrected.
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Validity of a German Comprehensive Psychosocial Screening Instrument based on the ESC Cardiovascular Prevention Guidelines. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2023; 69:76-97. [PMID: 36927319 DOI: 10.13109/zptm.2023.69.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background: Following guidelines for cardiovascular disease prevention of the European Society for Cardiology (ESC), the current study validated the German Comprehensive Psychosocial Screening Instrument in participants who underwent coronary angiography. Methods: 314 participants (Mage = 69.7 ± 12.0; 69 % male) completed the German Comprehensive Psychosocial Screening Instrument and validated comparison scales to measure depression (PHQ-9), anxiety (GAD-7), Type D personality (DS14), work stress (ERI), family stress (SMSS), trauma (PC-PTSD), and anger and hostility (Z-scale of MMPI-2). Results: Confirmatory factor analysis (CFA) confirmed that the psychosocial risk factors were separate entities rather than a signs or symptoms of a single broad indication of distress (CFI = .872, RMSEA = .056, SRMR = .058). Intraclass coefficients (ICC), kappa and diagnostic accuracy indicators (receiver operator characteristic [ROC] curves, sensitivity, specificity, and the positive and negative predictive values [PPV; NPV]) indicated that most screener scales were sufficient to good. We also compared patients with established coronary heart disease (CHD; n = 213) to those with no current CHD (n = 100) and found overall similar results. Discussion: The German version of the Comprehensive Psychosocial Screening Instrument has an acceptable performance. Aside from minor improvements, the screening instrument could be implemented in the cardiological practice to screen patients on multidimensional psychosocial risk.
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Feasibility of Risk Factor-Based Screening for Posttraumatic Stress Disorder in Trauma. J Trauma Nurs 2023; 30:27-33. [PMID: 36633342 DOI: 10.1097/jtn.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) following traumatic injury can have severe psychiatric consequences. Current recommendations from the American College of Surgeons Committee on Trauma require implementing PTSD screening but specify neither who should be screened nor how. It is unknown whether narrowed screening selection criteria could identify an acceptable proportion of patients with PTSD. OBJECTIVE This study aimed to determine the feasibility of implementing risk factor-based PTSD screening in trauma patients by evaluating the sensitivity and clinical practicality. METHODS This is a prospective diagnostic study of a consecutive series of general ward patients at an urban Level I trauma center from December 2021 to March 2022. Screening indications included (a) interpersonal injury, (b) surgery, (c) intracranial hemorrhage, (d) less than 30 years of age, or (e) clinical suspicion. The protocol was assessed by measuring the proportion of positive screens captured by only clinical suspicion to estimate sensitivity and by qualitatively evaluating barriers to implementation. RESULTS Among the 200 patients screened, the number of patients who screened positive was 51 (25.5%). Eight patients were screened on clinical suspicion alone, seven (87.5%) of whom had positive screens, compared with 44 of the 192 (22.9%) patients who were screened for indications. Thus, 7 of 51 (13.7%; 95% confidence interval: 6.8%-26.7%) patients with PTSD-level symptoms would not have been screened on the basis of their risk factors. There were also practical difficulties in implementation. CONCLUSION Limiting PTSD screening to only those injured patients with additional risk factors would have reduced overall sensitivity at our center. Consequently, we have implemented universal screening instead.
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van den Houdt S, Albus C, Herrmann-Lingen C, Widdershoven J, Kupper N. Validity of a multidimensional comprehensive psychosocial screening instrument based on the ESC cardiovascular prevention guidelines - Evidence from the general and cardiovascular patient population. J Psychosom Res 2022; 157:110791. [PMID: 35398675 DOI: 10.1016/j.jpsychores.2022.110791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the psychometric properties and validity of the updated version of the Dutch multidimensional Comprehensive Psychosocial Screening Instrument in patients with coronary heart disease and the general population, based upon guideline recommendations from the European Society for Cardiology. METHOD 678 participants (Mage = 48.2, SD = 16.8; 46% male) of the Dutch general population and 312 cardiac patients (Mage = 65.9, SD = 9.9; 77% male) who recently received percutaneous coronary intervention completed the Comprehensive Psychosocial Screening Instrument and validated questionnaires for depression (PHQ-9), anxiety (GAD-7), Type D personality (DS14), hostility (CMHS), anger (STAS-T), trauma (SRIP), and chronic work and family stress (ERI, MMQ-6). RESULTS Confirmatory factor analysis (CFA) confirmed that the eight screened risk factors were best measured as separate entities, rather than broader indications of distress. Inter-instrument agreement, assessed with the intraclass coefficient (ICC) and the screening accuracy indicators (receiving operator characteristic [ROC] curves, sensitivity, specificity, and the positive and negative predictive values [PPV; NPV]) were good for most screened risk factors. PPV was low in low prevalence risk factors like anxiety, trauma, and depression. CONCLUSION Overall, the current version of the Comprehensive Psychosocial Screening Instrument has an acceptable performance in both populations, with a fair to excellent level of agreement with established full questionnaires. Besides a few suggestions for further refinement, the screener may be implemented in primary care and cardiological practice.
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Affiliation(s)
- Sophie van den Houdt
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands.
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital of Cologne, Germany.
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Germany.
| | - Jos Widdershoven
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, the Netherlands
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands.
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Rawashdeh R, Al Qadire M, Alshraideh J, Al Omari O. Prevalence of post-traumatic stress disorder and its predictors following coronary artery bypass graft surgery. ACTA ACUST UNITED AC 2021; 30:794-800. [PMID: 34251851 DOI: 10.12968/bjon.2021.30.13.794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cardiac surgery can be traumatic and stressful, and as a result many people experience psychological difficulties following treatment. AIM To assess the level of post-traumatic stress disorder (PTSD) 1 month after coronary artery bypass graft (CABG) surgery among Jordanian patients, and to examine the predictors of PTSD after 1 month. METHOD A descriptive survey design was used. FINDINGS 149 patients participated in the study. Their mean age was 59 years (SD=10.2) and most were male (87%) and married (93%). Some 44% of patients had PTSD. Length of stay in hospital (c² (1)=6.598, P<0.05), and age (c² (1)=4.920, P<0.05), predicted the occurrence of PTSD after 1 month. CONCLUSIONS Nurses, who are usually in the frontline with patients, should consider using a robust tool and clinical interview to assess and evaluate the presence and the risks of PTSD to promote early detection and optimal management. Follow-up studies after 6 and 12 months would be beneficial.
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Affiliation(s)
- Rana Rawashdeh
- Dean, Prince Aisha Nursing College, Royal Medical Services, Amman, Jordan
| | - Mohammad Al Qadire
- Associate Professor, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman; and Associate Professor, Faculty of Nursing, Al Al-Bayt University, Jordan
| | - Jafar Alshraideh
- Professor, Faculty of Nursing, Clinical Nursing Department, The University of Jordan, Amman, Jordan
| | - Omar Al Omari
- Associate Professor, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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Schneider KE, Tomko C, Nestadt DF, Silberzahn BE, White RH, Sherman SG. Conceptualizing overdose trauma: The relationships between experiencing and witnessing overdoses with PTSD symptoms among street-recruited female sex workers in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:102859. [PMID: 32712164 PMCID: PMC7854789 DOI: 10.1016/j.drugpo.2020.102859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The opioid crisis has rendered witnessing and experiencing overdoses a common occurrence, especially among marginalized and drug using populations, including female sex workers (FSW). Such exposures may confer psychological trauma that has gone unrecognized. We explored relationships between experiencing and witnessing overdoses and PTSD symptomology to understand the traumatic nature of these experiences. METHODS Data were from FSW (N = 380) in Baltimore City, Maryland, who reported whether they had witnessed/experienced any overdoses in the past 6 months ("overdose traumas") and PTSD symptoms (PCL-5). We tested for associations between overdose traumas and PTSD diagnoses/symptomology in bivariate logistic regression models and multivariate models, adjusting for sociodemographic, experiences of violence, and drug use characteristics. RESULTS In our sample, 35.3% witnessed a fatal overdose, 51.9% witnessed a non-fatal overdose, and 28.3% experienced an overdose in the past 6 months. More than half (52.4%) met criteria for PTSD. Most endorsed symptoms within each PTSD domain: 63.2% for intrusive, 58.4% for avoidance, 66.1% for cognition/mood, and 64.7% for arousal/reactivity symptoms. Experiencing an overdose was associated with meeting PTSD criteria and symptoms in all domains in bivariate models. Witnessing an overdose was associated with PTSD diagnoses and intrusive and arousal/reactivity symptoms in bivariate models. Adjusting for sociodemographic characteristics and drug use, experiencing an overdose was associated with intrusive and cognition/mood symptoms, while neither trauma remained associated with PTSD diagnoses. CONCLUSIONS Traumas related to overdose, coined "overdose traumas" appear to be extremely psychologically traumatic, though the relationships vary by type and symptom. Programs should be cognizant of psychological trauma to address the full spectrum of overdose harms. Existing measures of PTSD do not accurately represent the effects of overdose traumas in populations like FSW due to the structural barriers to avoiding locations/situations where overdoses may occur and the overlap between symptoms, drug effects, and adaptive responses to homelessness.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, 305 E. 23rd St., Austin, TX 78712, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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15
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Bruyninx G, Grenier J, Greenman PS, Tassé V, Abdulnour J, Chomienne MH. Prevalence of Symptoms of Anxiety Disorders and Depression in Cardiac Rehabilitation Patients in an Academic Hospital: a Case Study. Psychiatr Q 2021; 92:273-287. [PMID: 32621076 DOI: 10.1007/s11126-020-09791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012-2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.
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Affiliation(s)
- Gladys Bruyninx
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada.
| | - Jean Grenier
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Paul S Greenman
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
- Université du Québec en Outaouais, 283, boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada
| | - Vanessa Tassé
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Joseph Abdulnour
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Marie Hélène Chomienne
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada
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16
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Rapelli G, Donato S, Pagani AF, Parise M, Iafrate R, Pietrabissa G, Giusti EM, Castelnuovo G, Bertoni A. The Association Between Cardiac Illness-Related Distress and Partner Support: The Moderating Role of Dyadic Coping. Front Psychol 2021; 12:624095. [PMID: 33679540 PMCID: PMC7925924 DOI: 10.3389/fpsyg.2021.624095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.
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Affiliation(s)
- Giada Rapelli
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Silvia Donato
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Ariela Francesca Pagani
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Miriam Parise
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Raffaella Iafrate
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Emanuele Maria Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anna Bertoni
- Department of Psychology, Family Studies and Research University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
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Desveaux L, Saragosa M, Russell K, McCleary N, Presseau J, Witteman HO, Schwalm JD, Ivers NM. How and why a multifaceted intervention to improve adherence post-MI worked for some (and could work better for others): an outcome-driven qualitative process evaluation. BMJ Open 2020; 10:e036750. [PMID: 32883724 PMCID: PMC7473621 DOI: 10.1136/bmjopen-2019-036750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore (1) the extent to which a multicomponent intervention addressed determinants of the desired behaviours (ie, adherence to cardiac rehabilitation (CR) and cardiovascular medications), (2) the associated mechanism(s) of action and (3) how future interventions might be better designed to meet the needs of this patient population. DESIGN A qualitative evaluation embedded within a multicentre randomised trial, involving purposive semistructured interviews. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS Potential participants were stratified according to the trial's primary outcomes of engagement and adherence, resulting in three groups: (1) engaged, adherence outcome positive, (2) engaged, adherence outcome negative and (3) did not engage, adherence outcome negative. Participants who did not engage but had positive adherence outcomes were excluded. Individual domains of the Theoretical Domains Framework were applied as deductive codes and findings were analysed using a framework approach. RESULTS Thirty-one participants were interviewed. Participants who were engaged with positive adherence outcomes attributed their success to the intervention's ability to activate determinants including behavioural regulation and knowledge, which encouraged an increase in self-monitoring behaviour and awareness of available supports, as well as reinforcement and social influences. The behaviour of those with negative adherence outcomes was driven by beliefs about consequences, emotions and identity. As currently designed, the intervention failed to target these determinants for this subset of participants, resulting in partial engagement and poor adherence outcomes. CONCLUSION The intervention facilitated CR adherence through reinforcement, behavioural regulation, the provision of knowledge and social influence. To reach a broader and more diverse population, future iterations of the intervention should target aberrant beliefs about consequences, memory and decision-making and emotion. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry; NCT02382731.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Kirstie Russell
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nicola McCleary
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
| | - J-D Schwalm
- Translation and Health Systems Research Program, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Noah Michael Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Alzahrani AS, Alqahtani A, Saleh A, Aloqalaa M, Abdulmajeed A, Nadhrah A, Alhazmi N. Prevalence of Psychiatric Disorders in Cardiac Outpatients. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200807-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Combined profiles derived from cardiovascular risk factors, health-promoting lifestyle, and post-traumatic stress disorder symptoms. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Bithas C, Harky A. Should Doctors Know Their Patients' Attachment Style? A Psychological Perspective and its Impact on Cardiac Surgery Outcomes. Braz J Cardiovasc Surg 2020; 35:100-108. [PMID: 32270966 PMCID: PMC7089750 DOI: 10.21470/1678-9741-2019-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To increase our understanding of the psychological attachment styles in order to develop a preventative strategy that could potentially improve patients’ perioperative outcomes. Methods A comprehensive literature search was performed utilizing major electronic databases. The search was done from inception to January 2019. All of the relevant papers have been extracted and critically appraised in this review. Results Understanding the psychological aspects of patients is crucial for a satisfactory postoperative outcome. Depression and anxiety have been shown to increase both mortality and morbidity after coronary artery bypass graft surgery, independently of medical factors, although the behavioural and biological mechanisms are poorly understood. Psychosocial assessment is an important part of the pre-transplant evaluation process. The majority of individuals undergoing a transplant have significant psychosocial problems and can either be deferred or denied the transplant until these psychosocial issues are approached and managed. Psychological distress has been shown to affect long-term prognosis of cardiac patients and as a result, it should be addressed during follow-up of cardiac arrest survivors due to cardiac cause. Several studies have considered different approaches and analyses of different psychological attachments, and the understanding of such parameters perioperatively could possibly minimise perioperatively complications. Conclusion Since psychological distress affects long-term prognosis of cardiac surgery patients, it should be addressed during follow-up of cardiac arrest survivors due to cardiac cause.
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Affiliation(s)
- Christiana Bithas
- University of Liverpool School of Medicine Liverpool UK School of Medicine, University of Liverpool, Liverpool, UK
| | - Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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21
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Tully PJ, Cosh SM. Post-traumatic Stress Disorder in Heart Failure Patients: A Test of the Cardiac Disease-induced PTSD Hypothesis. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191113121558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:Post-traumatic stress disorder (PTSD) is prevalent in approximately 12% of patients with cardiovascular disease (CVD) and such patients are at risk of further CVD morbidity and mortality. It is unknown whether CVD patients with cardiac and non-cardiac traumatic events leading to PTSD differ in medical comorbidities and psychiatric vulnerabilities. Our objective was to compare heart failure (HF) patients with cardiac and non-cardiac PTSD.Method:A population of HF patients from 3 hospitals underwent a two-step depression and anxiety screening process to identify potential mental health treatment needs. The post-traumatic stress disorder module of the Structured Clinical Interview for DSM-IV Axis-I disorders was used to classify trauma(s) exposure, and other disorders. The patients with PTSD were sub-divided by cardiac related traumas (e.g. myocardial infarction, sudden cardiac arrest) and non-cardiac related traumas (e.g. sexual abuse, interpersonal violence).Results:10 patients met criteria for non-cardiac trauma and 18 patients met criteria for cardiacinduced trauma. There were no significant differences in HF aetiology or severity nor cardiac comorbidities. Time since PTSD, onset was significantly longer for those with non-cardiac PTSD. Among psychiatric comorbidities, alcohol and substance abuse disorders, as well as depression were more prevalent in patients with non-cardiac PTSD.Conclusion:Cardiac related PTSD was associated with less alcohol and substance abuse disorders, and depression by comparison to their non-cardiac induced PTSD counterparts. Ongoing research is required to establish if cardiac-induced PTSD truly reflects a unique subtype of PTSD, and whether there are different treatment needs and therapeutic approaches for this subtype.
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Affiliation(s)
- Phillip J. Tully
- Freemasons Foundation Centre for Men’s Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, Australia
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22
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Sommer JL, El-Gabalawy R, Mota N. Understanding the association between posttraumatic stress disorder characteristics and physical health conditions: A population-based study. J Psychosom Res 2019; 126:109776. [PMID: 31327594 DOI: 10.1016/j.jpsychores.2019.109776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is commonly comorbid with a range of physical health conditions. The aim of this study was to examine the association between index trauma and PTSD symptom clusters with physical health conditions, among individuals with PTSD in a population-based sample. Data were analyzed from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). Past-year PTSD (n = 1779) was assessed using a clinical interview in accordance with DSM-5 criteria. Multiple logistic regression models examined the associations between PTSD symptom clusters and index trauma with physical health conditions. Results of the most stringent model, adjusting for sociodemographics, other psychiatric conditions, and other PTSD symptom clusters, indicated re-experiencing symptoms were associated with cardiovascular and endocrine/metabolic conditions (adjusted odds ratio (AOR) range: 1.18-1.33) and negative alterations in mood and cognition symptoms were associated with sleep disorder (AOR = 1.16, 95% confidence interval (CI) [1.04-1.30], p = .009). Results also demonstrated significant associations between life-threatening illness with cancer, digestive, and neurologic conditions (AOR range: 2.10-3.42) and life-threatening injury with musculoskeletal and neurologic conditions (AOR range: 1.76-2.04). Finally, significant associations emerged between psychological trauma with musculoskeletal and neurologic conditions (AOR range: 0.48-0.66), and other trauma with digestive conditions and anemia (AOR range: 0.38-0.47). Results suggest PTSD symptomatology and index trauma play a differential role in their association with variable physical health conditions. Results may inform screening practices and targeted interventions to mitigate risk of PTSD and physical health conditions.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
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23
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Allabadi H, Probst-Hensch N, Alkaiyat A, Haj-Yahia S, Schindler C, Kwiatkowski M, Zemp E. Mediators of gender effects on depression among cardiovascular disease patients in Palestine. BMC Psychiatry 2019; 19:284. [PMID: 31510958 PMCID: PMC6739957 DOI: 10.1186/s12888-019-2267-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Among patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD). METHODS Using a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM). RESULTS Women were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression. CONCLUSION This study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being.
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Affiliation(s)
- Hala Allabadi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4001, Basel, Switzerland. .,Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, P.O. Box 7, Nablus, Palestine.
| | - Nicole Probst-Hensch
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Abdulsalam Alkaiyat
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3University of Basel, Petersplatz 1, 4001 Basel, Switzerland ,0000 0004 0631 5695grid.11942.3fFaculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, P.O. Box 7, Nablus, Palestine
| | - Saleem Haj-Yahia
- 0000 0004 0631 5695grid.11942.3fAn-Najah National University Hospital, Asira Street, Nablus, Palestine ,0000 0004 1936 7603grid.5337.2School of Clinical Sciences, University of Bristol, 69 St Michael’s Hill, Bristol, BS2 8DZ UK ,0000 0001 2193 314Xgrid.8756.cInstitute of Cardiovascular and Medical Sciences, Glasgow University, 126 University Place, Glasgow, G12 8TA UK
| | - Christian Schindler
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Marek Kwiatkowski
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Elisabeth Zemp
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3University of Basel, Petersplatz 1, 4001 Basel, Switzerland
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Jahanpour F, Armoon B, Mozafari N, Motamed N, Poor DI, Mirzaee MS. The comparison of the effect of poetry therapy on anxiety and post-traumatic stress disorders in patients with myocardial infarction. JOURNAL OF POETRY THERAPY 2019. [DOI: 10.1080/08893675.2019.1639884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Faezeh Jahanpour
- School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Nasrin Mozafari
- General Department, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Niloofar Motamed
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Darush Iran Poor
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohammad Saeed Mirzaee
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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25
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Pedras S, Preto I, Carvalho R, Graça Pereira M. Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study. Psychol Health 2019; 34:535-549. [PMID: 30632805 DOI: 10.1080/08870446.2018.1545907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation. DESIGN A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients. MAIN OUTCOME MEASURES IES-R, WOC and HADS. RESULTS Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment. CONCLUSIONS Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.
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Affiliation(s)
- Susana Pedras
- a School of Psychology , University of Minho , Braga , Portugal
| | - Isabel Preto
- b Faculty of Engineering , University of Porto , Porto , Portugal
| | | | - M Graça Pereira
- a School of Psychology , University of Minho , Braga , Portugal
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27
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Ofman P, Hoffmeister P, Kaloupek DG, Gagnon DR, Peralta A, Djousse L, Gaziano JM, Rahilly-Tierney CR. Posttraumatic stress disorder and mortality in VA patients with implantable cardioverter-defibrillators. Clin Cardiol 2018. [PMID: 29532498 DOI: 10.1002/clc.22945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The association between posttraumatic stress disorder (PTSD) and mortality in patients undergoing implantable cardioverter-defibrillator (ICD) placement has not been evaluated in US veterans. HYPOTHESIS PTSD in veterans with ICD is associated with increased mortality. METHODS We studied a retrospective cohort of 25 678 veterans who underwent ICD implantation between September 30, 2002, and December 31, 2011. Of these subjects, 3280 carried the diagnosis of PTSD prior to ICD implantation. Primary outcome was all-cause mortality between date of ICD implantation and end of follow-up (September 30, 2013). We used Cox proportional hazard models to compute multivariable adjusted hazard ratios with corresponding 95% confidence intervals for the relation between PTSD diagnosis and death following ICD placement. RESULTS During a mean follow-up of 4.21 ± 2.62 years, 11 015 deaths were reported. The crude incidence rate of death was 87.8 and 103.9/1000 person-years for people with and without PTSD, respectively. We did not find an association between presence of PTSD before or after ICD implantation and incident death when adjusted for multiple risk factors (hazard ratio: 1.003, 95% confidence interval: 0.948-1.061). In secondary analysis, no statistically significant association was found. CONCLUSIONS In this retrospective cohort study among more than 25 000 veterans undergoing ICD implantation, almost 13% had a diagnosis of PTSD. Subjects with PTSD were significantly younger, yet they had a higher incidence of coronary heart disease, major cardiac comorbidities, cancer, and mental health conditions. We found no association between presence of PTSD before or after ICD implantation and incident death when adjusting for all covariates.
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Affiliation(s)
- Peter Ofman
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter Hoffmeister
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Danny G Kaloupek
- National Center for Posttraumatic Stress Disorders, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - David R Gagnon
- Division of Psychology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Adelqui Peralta
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts
| | - J Michael Gaziano
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine R Rahilly-Tierney
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
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28
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Lee SM, Han H, Jang KI, Huh S, Huh HJ, Joo JY, Chae JH. Heart rate variability associated with posttraumatic stress disorder in victims' families of sewol ferry disaster. Psychiatry Res 2018; 259:277-282. [PMID: 29091829 DOI: 10.1016/j.psychres.2017.08.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure.
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Affiliation(s)
- Sang Min Lee
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyesung Han
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Kuk-In Jang
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Huh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Hyu Jung Huh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Ji-Young Joo
- Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea; Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
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29
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Kumar M, Nayak PK. Psychological sequelae of myocardial infarction. Biomed Pharmacother 2017; 95:487-496. [PMID: 28866415 DOI: 10.1016/j.biopha.2017.08.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 01/10/2023] Open
Abstract
Patient with myocardial infarction (MI) are often affected by psychological disorders such as depression, anxiety, and post-traumatic stress disorder. Psychological disorders are disabling and have a negative influence on recovery, reduce the quality of life and causes high mortality rate in MI patients. Despite tremendous advancement in technologies, screening scales, and treatment strategies, psychological sequelae of MI are currently understudied, underestimated, underdiagnosed, and undertreated. Depression is highly prevalent in MI patients followed by anxiety and post-traumatic stress disorder. Pathophysiological factors involved in psychopathologies observed in patients with MI are sympathetic over-activity, hypothalamic-pituitary-adrenal axis dysfunction, and inflammation. Numerous preclinical and clinical studies evidenced a positive association between MI and psychopathologies with a common molecular pathophysiology. This review provides an update on diagnostic feature, prevalence, pathophysiology, clinical outcomes, and management strategies of psychopathologies associated with MI. Moreover, preclinical research findings on molecular mechanisms involved in post-MI psychopathologies and future therapeutic strategies have been outlined in the review.
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Affiliation(s)
- Mukesh Kumar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India.
| | - Prasanta Kumar Nayak
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India.
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30
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Vilchinsky N, Ginzburg K, Fait K, Foa EB. Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review. Clin Psychol Rev 2017; 55:92-106. [DOI: 10.1016/j.cpr.2017.04.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/25/2022]
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31
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Shapiro PA. Psychiatric Aspects of Heart Disease (and Cardiac Aspects of Psychiatric Disease) in Critical Care. Crit Care Clin 2017; 33:619-634. [PMID: 28601137 DOI: 10.1016/j.ccc.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Strong emotional reactions are common in patients admitted to cardiac critical care; only some are pathological. Cardiac critical care and associated technologies are associated with predictable psychiatric problems. Many occur as secondary complications of the medical status of the patient, which must be carefully assessed. Depression is common in patients with coronary disease and also for patients with heart failure; treatment is helpful, but persistent depression is associated with elevated morbidity and mortality. Preexisting psychiatric disorders may predispose to heart disease, and they and their treatment may affect critical care management.
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Affiliation(s)
- Peter A Shapiro
- Department of Psychiatry, Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, 622 West 168 Street Box 427, New York, NY 10032, USA; Consultation-Liaison Psychiatry Service, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168 Street, New York, NY 10032, USA.
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32
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Singh A, Agrawal S, Gargya S, Saluja S, Kumar A, Kumar A, Kalra K, Thind M, Saluja S, Stone LE, Ali F, Duarte-Chavez R, Marchionni C, Sholevar F, Shirani J, Nanda S. Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting. Int J Crit Illn Inj Sci 2017; 7:84-90. [PMID: 28660161 PMCID: PMC5479081 DOI: 10.4103/ijciis.ijciis_27_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.
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Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sanchita Gargya
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Sabir Saluja
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Akshat Kumar
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Abhishek Kumar
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Kartik Kalra
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Munveer Thind
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Sajeev Saluja
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Lauren E Stone
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Farhan Ali
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Rodrigo Duarte-Chavez
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Christine Marchionni
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Farhad Sholevar
- Department of Psychiatry, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sudip Nanda
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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33
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Thome J, Densmore M, Frewen PA, McKinnon MC, Théberge J, Nicholson AA, Koenig J, Thayer JF, Lanius RA. Desynchronization of autonomic response and central autonomic network connectivity in posttraumatic stress disorder. Hum Brain Mapp 2016; 38:27-40. [PMID: 27647521 DOI: 10.1002/hbm.23340] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/26/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Although dysfunctional emotion regulatory capacities are increasingly recognized as contributing to posttraumatic stress disorder (PTSD), little work has sought to identify biological markers of this vulnerability. Heart rate variability (HRV) is a promising biomarker that, together with neuroimaging, may assist in gaining a deeper understanding of emotion dysregulation in PTSD. The objective of the present study was, therefore, to characterize autonomic response patterns, and their related neuronal patterns in individuals with PTSD at rest. METHODS PTSD patients (N = 57) and healthy controls (N = 41) underwent resting-state fMRI. Connectivity patterns of key regions within the central autonomic network (CAN)-including the ventromedial prefrontal cortex (vmPFC), amygdala, and periaqueductal gray (PAG)-were examined using a seed-based approach. Observed connectivity patterns were then correlated to resting HRV. RESULTS In contrast to controls, individuals with PTSD exhibited lower HRV. In addition, whereas controls engaged a localized connectivity pattern of CAN-related brain regions, in PTSD, key CAN regions were associated with widespread connectivity patterns in regions related to emotional reactivity (vmPFC and amygdala to insular cortex and lentiform nucleus; PAG to insula) and motor readiness (vmPFC and amygdala to precentral gyrus; PAG to precentral gyrus and cerebellum). Critically, whereas CAN connectivity in controls was strongly related to higher HRV (insula, mPFC, superior frontal cortex, thalamus), HRV covariation was absent in PTSD subjects. CONCLUSIONS This study provides the first evidence for a specific psychophysiological-neuronal profile in PTSD individuals characterized by lower resting HRV and a lack of HRV covariation with CAN-related brain connectivity. Hum Brain Mapp 38:27-40, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Janine Thome
- Medical Faculty Mannheim, Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Germany
| | - Maria Densmore
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
| | - Paul A Frewen
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Department of Psychology, University of Western Ontario, London, Ontario, Canada.,Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioral Neurosciences, Mc Master University, Hamilton, Ontario, Canada
| | - Jean Théberge
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Department of Medical Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Andrew A Nicholson
- Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
| | - Julian Koenig
- Department of Psychology, Ohio State University, Columbus, Ohio.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian F Thayer
- Department of Psychology, Ohio State University, Columbus, Ohio
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
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34
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Roberts CR, Wofford JE, Hoy HM, Faddis MN. Implementation of a Screening Program for Patients at Risk for Posttraumatic Stress Disorder. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:129-37. [PMID: 27547041 PMCID: PMC4978196 DOI: 10.4137/cmc.s39957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/27/2016] [Accepted: 07/16/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Implantable cardioverter defibrillator (ICD) recipients who suffer from posttraumatic stress disorder (PTSD) are known to be associated with significant cardiac-specific mortality. Clinical observations suggest that PTSD is frequently undetected in ICD recipients followed up at electrophysiology (EP) outpatient clinics. Early recognition of PTSD is important to reduce the risk of serious manifestations on patient outcomes. METHODS All ICD recipients aged 19 years or older at the Washington University School of Medicine (WASHU) EP clinic, a large urban EP clinic, were invited to participate in the project. An informed consent letter with an attached primary care: posttraumatic stress disorder (PC: PTSD) survey was offered to the participants who met the inclusion criteria. Those who completed the survey were included in the project. Individuals with positive survey result were offered a referral to mental health services. Comparisons between PTSD and non-PTSD patients were done using a two-sample t-test for continuous variables. Using Fisher’s exact test, PTSD prevalence was compared to the study by Ladwig et al in which prevalence was determined as the proportion of patients with positive findings of PTSD (n = 38/147). All analyses were conducted using SAS v9.4. The proportion of patients having PTSD was determined and an exact 95% confidence interval was evaluated based on the binomial distribution. RESULTS Using a convenience sample, 50 ICD recipients (33 males and 17 females) were enrolled. The project had a 30-day outcome period. Nine (18%) of the 50 participants had positive PC: PTSD findings and all these nine participants were referred to a mental health specialist. The current project demonstrated an 18% (9/50) PTSD prevalence rate when compared to a 26% (38/147) prevalence rate in the study by Ladwig et al (P = 0.34). Although this project did not demonstrate 20% PTSD prevalence rate, as hypothesized, the 18% PTSD prevalence rate is consistent with previous research. CONCLUSION The prevalence of PTSD noted in the current project is consistent with previous research and validates underrecognition of PTSD in ICD patients. Offering a referral to all ICD recipients at EP clinic visits with a positive PC: PTSD screening to a mental health specialist is an important step in reducing the risk of serious manifestations on patient outcomes.
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Affiliation(s)
- Carmen R Roberts
- Washington University School of Medicine Nurse Practitioner, Cardiac Electrophysiology, USA
| | - Joanie E Wofford
- University of Alabama in Huntsville, Clinical Assistant Professor, Graduate Programs, USA
| | - Haley M Hoy
- University of Alabama in Huntsville, Associate Dean, Graduate Programs Associate Professor, USA
| | - Mitchell N Faddis
- Washington University School of Medicine Associate Professor, Medicine Division of Cardiovascular Diseases, Section Head, Cardiac Electrophysiology, USA
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35
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Feng HP, Chien WC, Cheng WT, Chung CH, Cheng SM, Tzeng WC. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4464. [PMID: 27559951 PMCID: PMC5400317 DOI: 10.1097/md.0000000000004464] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.
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Affiliation(s)
- Hsin-Pei Feng
- Institute of Medical Sciences and School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wei-Tung Cheng
- Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung CityTaiwan (ROC)
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Shu-Meng Cheng
- Internal Medicine, School of Medicine and Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
- Correspondence: Wen-Chii Tzeng, School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC) (e-mail: )
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36
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Marke V, Bennett P. Predicting negative emotional states following first onset acute coronary syndrome. J Health Psychol 2015; 22:765-775. [PMID: 26613707 DOI: 10.1177/1359105315614996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study identified predictors of anxiety and depression in patients with acute coronary syndrome. Predictors included illness beliefs, fear/threat at the time of the cardiac event, threat reappraisal over time and social support. A total of 97 participants completed questionnaires in hospital and 1- and 6-month follow-up. Perceived threat and fear at the time of the cardiac event predicted affective response at both time points, partly mediated by threat reappraisal. Contemporaneous measures of illness beliefs contributed additional variance, although not always in the predicted direction: high concern and control over the illness were associated with emotional distress. Assessment of patients for risk of negative emotional outcomes of acute coronary syndrome needs to consider their beliefs about their illness and the degree of threat and fear experienced at the time of the event. Interventions need to help people cope with negative emotional states as well as challenging inappropriate illness beliefs.
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