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From the Institute of Psychology, Aarhus University, Denmark (H.S.); Medical Psychology, Department of Psychology and Health, Tilburg University, The Netherlands (S.S.P.).
Address correspondence and reprint requests to Helle Spindler, MSc, Institute of Psychology, Aarhus University, Nobelparken, Jens Chr. Skous Vej 4, DK-8000 Aarhus C, Denmark. E-mail: hellesp{at}psy.au.dk
Background: There is increasing recognition that patients after a cardiac event may be at risk of posttraumatic stress disorder (PTSD). The present article reviews studies looking at PTSD as a sequel of heart disease with a focus on prevalence, risk factors, and future research directions.
Methods: We conducted a search on PsychInfo and MEDLINE from 1980 to the present. Studies were included in the review if they looked at PTSD after a cardiac event, reported on the number of cases with PTSD, and had been published in English.
Results: We identified 25 studies that fulfilled the inclusion criteria, of which 7 reported on the follow-up of previously published studies. The prevalence of PTSD after heart disease varied from 0% to 38% across studies. PTSD has been most rigorously researched after myocardial infarction with the best-powered studies finding a prevalence rate of 15%. Studies including control groups showed that cardiac patients were at risk of developing PTSD. Risk factors included sociodemographic and psychological characteristics and aspects related to the cardiac event.
Conclusion: Despite substantial heterogeneity in the methodology of studies and differences in prevalence across studies, this review indicates that subgroups of patients are at risk of PTSD after a cardiac event. Future studies investigating PTSD as a sequel of heart disease should be more systematic, use a prospective study design with multiple assessments, and include sufficiently large samples. PTSD should not be ignored as a sequel of heart disease, given preliminary evidence that PTSD may be associated with nonadherence with medication and an increased risk of clinical adverse events.
Key Words: coronary artery disease • posttraumatic stress disorder • prevalence • risk • review
Abbreviations: CAD = coronary artery disease; HT = heart transplantation; PTSD = posttraumatic stress disorder; MI = myocardial infarction; SCA = sudden cardiac arrest; CHF = congestive heart failure; CS = cardiac surgery; PCI = percutaneous coronary intervention; CABG = coronary artery bypass surgery; DSM = Diagnostic and Statistical Manual.
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