School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany.
Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Witten, Germany.
BMC Psychiatry. 2021 Jun 7;21(1):295. doi: 10.1186/s12888-021-03303-1.
Cardio- and cerebrovascular events such as myocardial infarction (MI), stroke and transient ischemic attack (TIA) are leading causes of death and disability and have also been associated with poor mental outcomes. In addition, cardio- and cerebrovascular events may pose the risk of experiencing a sudden traumatic occurrence of symptoms during ictus and thus contribute to high rates of PTSD as well as high rates of subsequent depression and anxiety. Moreover, MI, TIA and stroke survivors with PTSD, depressive and anxiety symptoms may have poorer health-related quality of life (HRQoL) and poorer disease prognosis than patients who do not develop psychiatric symptoms after ictus. However, data on the prevalence of PTSD, anxiety and depression, as well as the HRQoL, coping strategies and potential risk factors for development of PTSD in these patients, are rare.
In an exploratory, descriptive study we interviewed 112 patients (54 MI, 18 TIA, 40 stroke; mean age: 69.5 years, 55.4% males) from three general physician practices and used psychometric self-assessment tools to determine the occurrence of PTSD and psychosomatic comorbidity, anxiety and depression and to assess HRQoL and coping strategies. We evaluated disease severity and compared the patient groups to each other. Moreover, we assessed psychological outcome differences between patients with or without PTSD after ictus.
The prevalence of PTSD after MI, TIA and stroke was 23.2%. The patients who developed PTSD had higher rates of depression, anxiety and maladaptive coping as well as reduced HRQoL. Adaptive coping was positively related to better mental HRQoL and negatively related to anxiety and depression. Disease severity of MI, TIA and stroke was not related to PTSD, depression, anxiety or physical HRQoL.
Experiencing MI, TIA or stroke means confronting a life-threatening event for those affected and, therefore, these can be regarded as traumatic events. Cerebral and cardiovascular events increase the risk of developing chronic PTSD with subsequent increased depression and anxiety and reduced HRQoL. These findings emphasize the need for early screening and diagnosis of PTSD in somatically ill patients, which should be followed by specialized treatment, as PTSD hampers overall (somatic) disease prognosis.
German Clinical Trials Register, DRKS00021730, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730 , registered 05/19/2020 - Retrospectively registered.
心肌梗死（MI）、中风和短暂性脑缺血发作（TIA）等心血管和脑血管事件是死亡和残疾的主要原因，也与不良心理结局有关。此外，心血管和脑血管事件可能会增加在中风期间突然发生症状的创伤性事件的风险，从而导致 PTSD 发生率较高，以及随后抑郁和焦虑的发生率较高。此外，患有 PTSD、抑郁和焦虑症状的 MI、TIA 和中风幸存者的健康相关生活质量（HRQoL）和疾病预后可能比中风后未出现精神症状的患者差。然而，关于这些患者 PTSD、焦虑和抑郁的患病率，以及 HRQoL、应对策略和 PTSD 发展的潜在危险因素的数据很少。
在一项探索性、描述性研究中，我们采访了来自三个全科医生诊所的 112 名患者（54 名 MI、18 名 TIA、40 名中风；平均年龄：69.5 岁，55.4%为男性），并使用心理测量自评工具来确定 PTSD 和心身共病、焦虑和抑郁的发生情况，以及评估 HRQoL 和应对策略。我们评估了疾病严重程度并将患者组相互比较。此外，我们评估了中风后 PTSD 患者与非 PTSD 患者之间的心理结果差异。
MI、TIA 和中风后 PTSD 的患病率为 23.2%。患有 PTSD 的患者抑郁、焦虑和适应不良的应对方式发生率更高，HRQoL 降低。适应性应对与更好的心理健康 HRQoL 呈正相关，与焦虑和抑郁呈负相关。MI、TIA 和中风的疾病严重程度与 PTSD、抑郁、焦虑或身体 HRQoL 无关。
经历 MI、TIA 或中风意味着对受影响的人来说是危及生命的事件，因此，这些可以被视为创伤性事件。脑卒中和心血管事件增加了患慢性 PTSD 的风险，随后增加了抑郁和焦虑，降低了 HRQoL。这些发现强调了对躯体疾病患者进行 PTSD 的早期筛查和诊断的必要性，随后应进行专门治疗，因为 PTSD 会影响整体（躯体）疾病预后。
德国临床试验注册处，DRKS00021730，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730，注册日期：2020 年 5 月 19 日-回顾性注册。
