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Scott AW, Cornelius T, Schwartz JE, Fray N, Kronish IM, Edmondson D. Posttraumatic stress disorder (PTSD) in a sample of patients evaluated for acute coronary syndrome: A factor analysis of the PTSD checklist for DSM-5 (PCL-5). J Affect Disord 2024:S0165-0327(24)01669-0. [PMID: 39374739 DOI: 10.1016/j.jad.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/28/2024] [Accepted: 10/02/2024] [Indexed: 10/09/2024]
Abstract
The PCL-5 is a psychometrically sound measure of Post-Traumatic Stress Disorder (PTSD) symptoms. Although the scale is commonly applied to past external traumas (e.g., combat, assault), PTSD symptoms have also been assessed about potentially life-threatening cardiovascular events that represent ongoing internal threats. To date, there is a paucity of studies that have examined the updated scale factor structure for PTSD in patients with suspected acute coronary syndromes (ACS). METHODS Exploratory and confirmatory factor analyses (EFA, CFA) were conducted using PCL-5 data completed by 830 patients enrolled in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Follow-up measurement invariance tests were conducted on pre-selected models and on the best-fitting model identified by EFA to evaluate invariance across diagnosis (confirmed v. rule-out ACS), sex, and language. RESULTS The EFA identified a two-factor model with "Memories of Trauma" (MT) and "Cognitive Behavioral Symptoms" (CBS) factors offering a balanced fit and interpretability. In CFAs, the Anhedonia CFA model performed the best overall. Measurement invariance tests supported strong invariance across confirmed and ruled-out ACS, male and female sex, and English and Spanish language for all models. LIMITATIONS Only 34 % of the sample was diagnosed with ACS at discharge, which limits generalizability. CONCLUSION Our study contributes to the understanding of PTSD in the context of internal traumatic reminders and may guide future research and clinical practice by informing intervention targets to improve health and well-being after suspected ACS.
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Affiliation(s)
- Allie W Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America.
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America
| | - Nakesha Fray
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States of America
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McBain S, Cordova MJ. Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology. J Trauma Stress 2024; 37:761-767. [PMID: 38970812 DOI: 10.1002/jts.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/08/2024]
Abstract
Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.
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Affiliation(s)
- Sacha McBain
- Departments of Psychiatry and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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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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Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
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Ovsyannikova Y, Pokhilko D, Krasnokutskyi M, Kerdyvar V, Kreshchuk K. The Nature of Combat Stress Development During Military Operations and Psychotherapy in Extreme Situations. J Nerv Ment Dis 2024; 212:270-277. [PMID: 38536039 DOI: 10.1097/nmd.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
ABSTRACT The purpose of the research work is the theoretical and empirical analysis of the study of the nature of combat stress in military personnel and the assessment of psychotherapeutic methods of providing psychological assistance in extreme situations. The authors used the following methods to achieve this goal: method of analysis and synthesis, hermeneutic method, testing method, comparative method, and generalization method. The results of the research work have revealed the meaning of traumatic stress, psychological trauma, and combat mental trauma, and explained the concept of combat stress and the dynamics of its growth. The findings identified the factors of posttraumatic stress syndrome and its prevalence, tracked down the dynamics of psychoemotional disorders, and revealed the importance of military psychological selection and determination of combat readiness. The authors established the main tasks of a staff psychologist in working with military personnel, conducted an empirical study of the nature of combat stress in the military, observed main psychotherapeutic tools for the prevention of negative mental states in combat conditions, and investigated self-regulation techniques of emotional, physical, and mental health. The practical significance of the scientific work lies in the modern coverage of the phenomenon of combat stress and the classification of effective psychotherapeutic methods that will ensure the sustainable psychological preparation of the soldiers for extreme situations.
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Affiliation(s)
- Yanina Ovsyannikova
- From the Educational and Scientific Laboratory of Extreme and Crisis Psychology, National University of Civil Defence of Ukraine, Kharkiv, Ukraine
| | - Diana Pokhilko
- From the Educational and Scientific Laboratory of Extreme and Crisis Psychology, National University of Civil Defence of Ukraine, Kharkiv, Ukraine
| | - Mykola Krasnokutskyi
- From the Educational and Scientific Laboratory of Extreme and Crisis Psychology, National University of Civil Defence of Ukraine, Kharkiv, Ukraine
| | - Valentyn Kerdyvar
- From the Educational and Scientific Laboratory of Extreme and Crisis Psychology, National University of Civil Defence of Ukraine, Kharkiv, Ukraine
| | - Kateryna Kreshchuk
- Social and Psychological Faculty, National University of Civil Defence of Ukraine, Kharkiv, Ukraine
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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Birk JL, Cornelius T, Kronish IM, Shechter A, Diaz KM, Schwartz JE, Garcia OG, Cruz GJ, Shaw K, Sanchez GJ, Agarwal S, Edmondson D. Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study. Gen Hosp Psychiatry 2024; 86:103-107. [PMID: 38181710 PMCID: PMC10872378 DOI: 10.1016/j.genhosppsych.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization. METHOD In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device. RESULTS Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients. CONCLUSIONS Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA.
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Othanya G Garcia
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gaspar J Cruz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Kaitlin Shaw
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA; Psychology Department, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY 8GS-300, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
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Luberto CM, Crute S, Wang A, Li R, Yeh GY, Huffman JC, Celano CM, Victorson D, Hoeppner BB, Park ER. Needs and Preferences for Remote-Delivered Mindfulness-Based Cognitive Therapy in Patients After Acute Coronary Syndrome: A Qualitative Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241288213. [PMID: 39376785 PMCID: PMC11457197 DOI: 10.1177/27536130241288213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/04/2024] [Accepted: 09/13/2024] [Indexed: 10/09/2024]
Abstract
Background Following acute coronary syndrome (ACS), up to 40% of patients report elevated depressive symptoms which is associated with a two-fold increase in mortality risk due to behavioral and biological mechanisms. Mindfulness-Based Cognitive Therapy (MBCT) delivered via synchronous group videoconferencing could help reduce depressive symptoms. Objective To guide MBCT adaptation for ACS patients for a future clinical trial, this qualitative study aimed to explore ACS patients' (1) symptoms after ACS, (2) needs for behavioral health treatment, (3) perspectives on mindfulness intervention and group videoconference delivery, and (4) willingness to self-collect dried blood spots in a research study. Methods We compared ACS patients with and without depressive symptoms to highlight particularly relevant treatment topics for patients developing depression following ACS experience. From 2/2019-11/2019, we conducted semi-structured individual telephone interviews with N = 23 patients after ACS (N = 13 with and N = 10 without elevated depressive symptoms; 63.4 (SD = 8.5) years, 87% male, 96% non-Hispanic white, 7.1 (SD = 7.5) years since ACS). In qualitative content analyses, four independent coders coded each interview. Results Participants with depressive symptoms experienced emotional, physical, social, and health behavior problems, while those without depressive symptoms made positive health behavior changes and struggled with anxiety symptoms. Both groups were interested in a behavioral health treatment for emotional and social support. Most were willing to participate in a mindfulness group via videoconferencing; some preferred in-person, but accessibility and convenience outweighed these cons. Almost all were willing to self-collect dried blood spots and some were already familiar with this technique. Conclusion ACS patients, especially those with depressive symptoms, need help managing a multitude of quality of life concerns that can be targeted with an adapted MBCT approach. A videoconference-delivered MBCT approach is of interest. Suggestions for adapting MBCT to target the needs of ACS patients are discussed.
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Affiliation(s)
- Christina M. Luberto
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney Crute
- Fordham University School of Law, New York, NY, USA
| | - Amy Wang
- Stony Brook University, Stony Brook, NY, USA
| | - Runnan Li
- Teachers College, Columbia University, New York, NY, USA
| | - Gloria Y. Yeh
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Osher Center for Integrative Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bettina B. Hoeppner
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, MA, USA
- Health through Flourishing Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R. Park
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Cornelius T, Casey JA, Just AC, Rowland ST, Edmondson D. Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms. Front Psychol 2023; 14:1092106. [PMID: 37325741 PMCID: PMC10267367 DOI: 10.3389/fpsyg.2023.1092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population. Methods Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES. Results No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS. Conclusion Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sebastian T. Rowland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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Edelman DS, Palmer DM, Romero EK, Chang BP, Kronish IM. Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome. J Gen Intern Med 2023; 38:946-953. [PMID: 36127540 PMCID: PMC10039209 DOI: 10.1007/s11606-022-07794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED). OBJECTIVE To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016. MAIN MEASURES English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression. KEY RESULTS Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93). CONCLUSIONS This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.
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Affiliation(s)
- David S Edelman
- Primary Care/Social Internal Medicine Residency Program, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dana M Palmer
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily K Romero
- Teachers College, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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11
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Liyanage-Don NA, Edelman DS, Chang BP, Schultebraucks K, Thanataveerat A, Kronish IM. Associations between emergency department crowding and perceptions of interpersonal care in patients presenting with suspected acute coronary syndrome. Emerg Med J 2022; 39:186-190. [PMID: 34400405 PMCID: PMC9308996 DOI: 10.1136/emermed-2020-210493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/02/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Emergency department (ED) crowding is associated with numerous healthcare issues, but little is known about its effect on psychosocial aspects of patient-provider interactions or interpersonal care. We examined whether ED crowding was associated with perceptions of interpersonal care in patients evaluated for acute coronary syndrome (ACS). METHODS Patients presenting to a quaternary academic medical centre ED in New York City for evaluation of suspected ACS were enrolled between November 2013 and December 2016. ED crowding was measured using the ED Work Index (EDWIN), which incorporates patient volume, triage category, physician staffing and bed availability. Patients completed the 18-item Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centred decision-making and interpersonal style. Regression analyses examined associations between EDWIN and IPC scores, adjusting for demographics, comorbidities and depression. RESULTS Among 933 included patients, 11% experienced ED overcrowding (EDWIN score >2) at admission, 11% experienced ED overcrowding throughout the ED stay and 30% reported suboptimal interpersonal care (defined as per-item IPC score <5). Higher admission EDWIN score was associated with modestly lower IPC score in both unadjusted (β=-1.70, 95% CI -3.15 to -0.24, p=0.02) and adjusted models (β = -1.77, 95% CI -3.31 to -0.24, p=0.02). EDWIN score averaged over the entire ED stay was not significantly associated with IPC score (unadjusted β=-1.30, 95% CI -3.19 to 0.59, p=0.18; adjusted β=-1.24, 95% CI -3.21 to 0.74, p=0.22). CONCLUSION Increased crowding at the time of ED admission was associated with poorer perceptions of interpersonal care among patients with suspected ACS.
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Affiliation(s)
- Nadia A Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA.,Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - David S Edelman
- Columbia University Mailman School of Public Health, New York, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA .,Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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12
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Cao X, Wu J, Gu Y, Liu X, Deng Y, Ma C. Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study. Front Psychol 2021; 12:694974. [PMID: 34970178 PMCID: PMC8712448 DOI: 10.3389/fpsyg.2021.694974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the status and risk factors of post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI) in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time (DTB) (≥92.6 min), left ventricular ejection fraction (LVEF) (<50%), smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI.
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Affiliation(s)
- Xiaocui Cao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaqi Wu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuqin Gu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuemei Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaping Deng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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13
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Liyanage-Don NA, Cornelius T, Romero EK, Alcántara C, Kronish IM. Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome. Prev Med Rep 2021; 23:101455. [PMID: 34194962 PMCID: PMC8237356 DOI: 10.1016/j.pmedr.2021.101455] [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] [Received: 10/29/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/06/2022] Open
Abstract
Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites – a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16–1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75–0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.
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Affiliation(s)
- Nadia A Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Emily K Romero
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Carmela Alcántara
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
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14
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Young J, Schweber A, Sumner JA, Chang BP, Cornelius T, Kronish IM. Impact of prior trauma exposure on the development of PTSD symptoms after suspected acute coronary syndrome. Gen Hosp Psychiatry 2021; 68:7-11. [PMID: 33232851 PMCID: PMC7855440 DOI: 10.1016/j.genhosppsych.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the association between PTSD symptoms due to prior trauma and prior trauma type with PTSD symptoms after suspected acute coronary syndrome (ACS). METHOD A consecutive sample of patients presenting to the emergency department (ED) for suspected ACS were surveyed. Logistic regression was used to estimate the odds of elevated ACS-related PTSD symptoms [PCL-S ≥ 33] at 1-month associated with PTSD symptoms due to prior trauma and prior trauma type at the time of suspected ACS, adjusting for demographics, comorbidities, depression, and etiology of ACS symptoms. RESULTS Of 984 patients, 81.6% reported ≥1 prior trauma type and 22.5% reported PTSD symptoms due to prior trauma at the time of suspected ACS. One month later, 18.0% had ACS-related PTSD symptoms. Patients with versus without PTSD symptoms due to prior trauma at the time of the suspected ACS had increased odds of ACS-related PTSD symptoms one month later (42.1% vs 9.9%; aOR 4.49, 95% CI:3.05-6.60; p < .001). Prior life-threatening illness was the only trauma type significantly associated with ACS-related PTSD symptoms (aOR 1.57, 95% CI:1.03-2.39; p = .04). CONCLUSIONS PTSD symptoms from prior trauma and history of life-threatening medical illness at the time of suspected ACS increased risk of ACS-related PTSD symptoms one month later.
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Affiliation(s)
- Justin Young
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA; Columbia University Vagelos College of Physicians and Surgeons, 630 W. 168th St, NY, New York, USA
| | - Adam Schweber
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA; Columbia University Vagelos College of Physicians and Surgeons, 630 W. 168th St, NY, New York, USA
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA; Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box, 951563, Los Angeles, CA, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th St, NY, New York, USA.
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15
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Birk JL, Cumella R, Lopez-Veneros D, Jurado A, Romero EK, Lazarov A, Kronish IM. Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial. Health Psychol 2020; 39:736-744. [PMID: 32833475 PMCID: PMC7449512 DOI: 10.1037/hea0000853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Many acute coronary syndrome (ACS) patients are nonadherent to cardiovascular medications despite their known benefits for lowering risk of recurrent cardiovascular events. Research suggests that greater cardiac-related fear of recurrence (FoR) may be associated with higher nonadherence to cardiovascular medications and avoidance of physical activity. We aim to test the effect of an intervention that targets FoR as a potentially modifiable mechanism underlying nonadherence to recommended health behaviors among patients with suspected ACS. METHOD The INFORM trial ("INvestigating Fear Of Recurrence as a modifiable Mechanism of behavior change to improve medication adherence in acute coronary syndrome patients") is a double-blind, parallel-group randomized clinical trial. It compares an 8-session, at-home, electronic tablet-delivered, cognitive bias modification training (CBMT) intervention with a sham control. Patients who experience high perceived threat at the time of presentation to the emergency department (ED) with a suspected ACS are enrolled and randomized within 6 weeks of their ED visit. The primary outcome, FoR, is measured by the adapted Concerns about Recurrent ACS Scale. The trial also tests the intervention's effect on a potential mechanism of health behavior change that is inversely correlated with fear: an expansive future time perspective. Additional outcomes include electronically measured adherence to a cardiovascular medication and self-reported physical activity. CONCLUSIONS This study takes a mechanistic approach to addressing the dangerous problem of poor health behaviors after ACS. The trial will test whether targeting FoR or future time perspective by CBMT is a promising approach to improving nonadherence after ACS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Robin Cumella
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - David Lopez-Veneros
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Ammie Jurado
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Emily K. Romero
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168 Street, New York, NY 10032, USA
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16
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Kronish IM, Cornelius T, Schwartz JE, Shechter A, Diaz KM, Romero EK, Edmondson D. Posttraumatic Stress Disorder and Electronically Measured Medication Adherence After Suspected Acute Coronary Syndromes. Circulation 2020; 142:817-819. [PMID: 32833523 DOI: 10.1161/circulationaha.120.045714] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
| | - Joseph E Schwartz
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, NY (J.E.S.)
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
| | - Emily K Romero
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York (I.M.K., T.C., J.E.S., A.S., K.M.D., E.K.R., D.E.)
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17
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Partner presence in the emergency department and adherence to daily cardiovascular medications in patients evaluated for acute coronary syndrome. J Behav Med 2020; 43:402-410. [PMID: 31997128 DOI: 10.1007/s10865-020-00139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
Stressful health situations may compromise spouses'/partners' ability to provide patients with support. We tested whether partner status/partner presence in the emergency department (ED) were associated with patients' adherence to daily cardiovascular medications and whether effects differed by age/gender. Participants were 189 patients evaluated for acute coronary syndrome at an urban academic ED (MAge = 62.18; 57.1% male; 58.7% Hispanic). Participants self-reported partner status/partner presence. Medication adherence was measured using an electronic pillcap. For male patients, having a partner was associated with increased adherence in the first month post-discharge, OR 1.94, p < .001, but having a partner present in the ED was associated with lower adherence, OR 0.33, p < .001. The opposite effect was evident for female patients. Partner status/partner presence in the ED are associated with medication adherence during the first month post discharge, with opposing effects for male and female patients.
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19
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Cornelius T, Derby L, Dong M, Edmondson D. The impact of support provided by close others in the emergency department on threat perceptions. Psychol Health 2019; 35:482-499. [PMID: 31328563 DOI: 10.1080/08870446.2019.1643023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Having close others present in the emergency department (ED) can cause patients significant distress. The present study tested the hypothesis that close others provide more negative support than non-close others as a potential explanation for this effect.Design: Participants were 493 patients evaluated for an acute coronary syndrome (ACS) in the ED (MAge = 62.01, SDAge = 13.55; 49.49% male) and who arrived with close others (i.e. spouse/partner, child) or non-close others (e.g. neighbour). Patients self-reported support from companions and threat perceptions (in-ED and at recall approximately three days later).Main outcome measures: Positive support (comfort, responsiveness); negative support (made patients anxious, required comforting); threat perceptions (feeling helpless, vulnerable).Results: Close (vs non-close) others provided patients with marginally more positive support, but also required more comfort, B = 0.32, p = .050, and caused patients more anxiety, B = 0.24, p = .009. Anxiety was associated with patients' Threat Perceptions: in-ED, B = 0.11, p = .002; recall, B = 0.14, p < .001; as was provision of comfort to support partners: recall, B = .06, p = .005.Conclusion: Negative support may be one mechanism underlying the association between close others and patient distress in the ED.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Melissa Dong
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
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