Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
Am J Cardiol. 2024 May 15;219:9-16. doi: 10.1016/j.amjcard.2024.03.007. Epub 2024 Mar 6.
Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.
心理创伤、创伤后应激障碍（PTSD）症状和心理健康问题在成人先天性心脏病（ACHD）中很常见。目前使用《精神疾病诊断与统计手册》第五版（DSM-5）标准评估患者特征和创伤聚焦治疗经历的研究中，对 ACHD 中的 PTSD 研究存在差距。在 6 个月的入组期间，通过患者个人智能手机上的二维码向门诊患者提供了调查。患者报告的项目包括详细的医疗和社会心理史、奥斯陆社会支持量表、不良童年经历调查和 DSM-5 的 PTSD 清单。在提供完整数据的 158 名患者（77%为中度或复杂心脏病）中，使用 DSM-5 的 PTSD 清单截断值≥31 发现 48 名患者（30%）有 PTSD 的暂定诊断。阳性 PTSD 筛查与年龄较小、非白种人、心力衰竭存在、纽约心脏协会功能分级较低、线性生活质量评分较低、奥斯陆社会支持量表评分较低、照顾者关系不安全、失业期、急诊就诊、药物不依从以及共存的心理健康障碍有关。心脏病的复杂性和手术及/或基于导管的干预次数与 PTSD 无关，尽管直到成年（年龄≥18 岁）才进行心脏手术与 PTSD 的患病率较低有关。那些 PTSD 筛查阳性的患者更有可能报告多种创伤事件，包括非心脏创伤事件。尽管 44 名患者（92%）报告曾看过心理健康提供者，但仅有 48 名患者（29%）报告已知 PTSD 诊断。共有 18 名患者（38%）报告目前有心理健康提供者。共有 30 名患者（62%）听说过至少 1 种循证创伤知情治疗方法，14 名患者（29%）尝试过至少 1 种。总之，使用 DSM-5 标准，我们观察到 ACHD 中与多种新的心脏和社会心理患者因素相关的 PTSD 发生率较高。未来的纵向研究将有必要确定因果关系。很少有 ACHD 患者被正式诊断为 PTSD 或有过循证创伤知情治疗的经验。
