von Känel Roland, Meister-Langraf Rebecca E, Barth Jürgen, Znoj Hansjörg, Schmid Jean-Paul, Schnyder Ulrich, Princip Mary
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
Clienia Schlössli AG, 8618 Oetwil am See, Switzerland.
J Clin Med. 2022 Apr 2;11(7):1993. doi: 10.3390/jcm11071993.
A one-size-fits-all approach might explain why early psychological interventions are largely ineffective in preventing the development of posttraumatic stress disorder (PTSD) symptoms triggered by acute medical events. We examined the hypothesis that social and health care resources are moderators of an intervention effect.
Within 48 h of hospital admission, 129 patients (mean age 58 years, 83% men) with acute coronary syndrome (ACS) self-rated their social support and were randomized to one single session of trauma-focused counseling (TFC) or stress-focused counseling (SFC) (active control intervention). Clinician-rated PTSD symptoms, use of cardiac rehabilitation (CR) and use of psychotherapy were assessed at 3 and 12 months. Random mixed regression multivariable models were used to analyze associations with PTSD symptoms over time.
TFC did not prevent ACS-induced PTSD symptom onset better than SFC; yet, there were significant and independent interactions between "intervention" (TFC or SFC) and social support ( = 0.013) and between "intervention" and duration of CR in weeks ( = 0.034). Patients with greater social support or longer participation in CR had fewer PTSD symptoms in the TFC group compared with the SFC group. The number of psychotherapy sessions did not moderate the intervention effect.
Early psychological intervention after ACS with a trauma-focused approach to prevent the development of PTSD symptoms may be beneficial for patients who perceive high social support or participate in CR for several weeks.
一刀切的方法或许可以解释为何早期心理干预在预防急性医疗事件引发的创伤后应激障碍（PTSD）症状方面大多无效。我们检验了社会和医疗保健资源是干预效果调节因素这一假设。
在入院48小时内，129例急性冠脉综合征（ACS）患者（平均年龄58岁，83%为男性）自评其社会支持情况，并被随机分为接受单次创伤聚焦咨询（TFC）或压力聚焦咨询（SFC，作为对照干预）。在3个月和12个月时评估临床医生评定的PTSD症状、心脏康复（CR）的使用情况及心理治疗的使用情况。采用随机混合回归多变量模型分析随时间推移与PTSD症状的关联。
TFC在预防ACS诱发的PTSD症状发作方面并不比SFC更有效；然而，“干预”（TFC或SFC）与社会支持之间（P = 0.013）以及“干预”与以周为单位的CR持续时间之间（P = 0.034）存在显著且独立的交互作用。与SFC组相比，TFC组中社会支持较多或参与CR时间较长的患者PTSD症状较少。心理治疗疗程数并未调节干预效果。
ACS后采用创伤聚焦方法进行早期心理干预以预防PTSD症状的发生，可能对那些感知到高社会支持或参与CR达数周的患者有益。
