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ORIGINAL ARTICLES |
From the Departments of Psychiatry (E.S., R.Y.), and Pediatrics (E.S.), Mount Sinai Medical Center, New York, NY, and the Clinical Pharmacological Research Unit, The Cardiology Institute, Assaf-Harofeh Medical Center, Zerifin, (O.M., I.D., Z.V., G.C.), and Sackler School of Medicine (A.R.), Tel Aviv University, Tel Aviv, Israel.
Address correspondence and reprint requests to Eyal Shemesh, M.D., Mount Sinai Medical Center, Box 1230, 1 Gustave L. Levy Place, New York, NY 10029. E-mail: eyal.shemesh{at}mssm.edu
OBJECTIVE: Posttraumatic stress disorder (PTSD) symptoms have been reported in patients with coronary vascular disease, after the trauma of a myocardial infarction (MI). The effect of these symptoms on post-MI disease control has not been elucidated. We conducted a study that sought to determine whether PTSD symptoms post-MI are associated with increased likelihood of cardiovascular readmission and with nonadherence to treatment recommendations.
METHODS: Patients were recruited during a visit in a cardiology clinic 6 months post-MI and were followed for 1 year. Adherence to aspirin was measured by platelet thromboxane production (an indication of aspirin’s effect). Medical outcome was measured as rate of admission due to cardiovascular causes during the follow-up period. Self-report measures of PTSD (Impact of Event Scale), Depression, and Global Distress (SCL-90-R) were administered at enrollment.
RESULTS: Seventy-three patients were studied. Above-threshold PTSD symptom scores at enrollment, but not depression or global distress scores, were significant predictors of nonadherence to aspirin and of an increased likelihood of cardiovascular readmission over the course of the following year.
CONCLUSIONS: PTSD symptoms predicted poor disease control in this cohort of MI survivors. The data suggest that screening MI survivors for symptoms of PTSD may be beneficial if this high-risk population is to be targeted for interventions.
Key Words: posttraumatic stress, • myocardial infarction, • adherence.
Abbreviations: PTSD = posttraumatic stress disorder;; MI = myocardial infarction;; IES = Impact of Event Scale;; SCL-90-R = Symptom Checklist-90-Revised.
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