Predicting post-traumatic symptoms in cardiac patients

OBJECTIVE: The purpose of this study was to identify correlates and predictors of the symptoms of post-traumatic stress disorder (PTSD) in a cohort of patients with myocardial infarction, while the patients were in hospital and 3 months after infarction. DESIGN: Longitudinal, consecutive referrals were used. PATIENTS: From a possible 68 consecutive patients with a first myocardial infarction who completed questionnaires in hospital and survived to 3-month follow-up, 39 completed follow-up questionnaires. OUTCOME MEASURES: PTSD measures were taken in hospital and 3 months after discharge, Predictor variables were measures of mood taken in hospital and measures of the immediate cognitive and emotional reactions at the time of the infarct. RESULTS: Associations between the independent variables and PTSD symptoms were stronger at 3-month follow-up than while in hospital. At this time, the frequency of intrusive thoughts was predicted by the degree of fright at the time of the event (adjusted R-2 = 0.262; beta = .57; t = 3.30; P < .01) and positive affect scores (additional adjusted R-2 = 0.112; beta = -.37 t = -2.18; P < .05). The degree of physiologic arousal at the time of such flashbacks was predicted by levels of negative affect in hospital (adjusted R-2 = 0.174, beta = .46; t = 2.46; P < .05), which also predicted avoidance scores (adjusted R-2 = 0.203; beta = .48; t = 2.62; P < .05). CONCLUSIONS: Because many of the symptoms of PTSD are self-remitting, and intervening too early in the course of the disorder may exacerbate the disorder, it is important not to intervene too early or over-treat this disorder, Formal treatment may be useful if provided sonic months after discharge from hospital. If either secondary or primary care services are to treat myocardial infarction-related PTSD effectively, it is important to identify patients who are at risk for it. These data contribute to the development of a profile of patients at risk.