Abstract
Aim of the studyThe study aims at a preliminary assessment of the occurrence of PTSD among patients awaiting major heart surgery and the assessment off the reliability of the Impact of Event Scale – Revised (IES-R).Subject or material and methods100 consecutive patients scheduled to non-emergency cardiac surgery were screened using a brief list of PTSD symptoms. Those who responded affirmatively, were ask to fill in the IES-R and then underwent structured Mini International Neuropsychiatric Interview (MINI) and a clinical assessment according to the DSM-5 criteria.ResultsFourteen of fifteen patients who completed the IES-R obtained results indicating a possibility of PTSD. Five of them refused to undergo a psychiatric examination. Four of nine patients whose IES-R scores indicated PTSD, met its criteria according to MINI. and DSM-5. One PTSD case was related to cardiological problems.DiscussionThe results of the present study do not support the hypothesis that heart disease is a stressor causing PTSD in patients awaiting cardiac surgery. Moreover, the results impair the conclusions suggesting high rate of PTSD occurrence among some populations of cardiological patients, in research conducted with self-rating scales. The results of the presented study demonstrate that clinical psychiatric examination is necessary to properly confirm a PTSD diagnosis.ConclusionsThe prevalence of PTSD (4%) in the study group was higher than in the general population in Poland, but the heart related stressor was found only in one case (1%), that is equal with the rate of PTSD. The reliability of IES-R is low due to a large number of false-positives.
Highlights
Identification of all stressors that can cause posttraumatic stress disorder (PTSD) is a challenge for modern psychiatry
One such study [4] compared an observed prevalence of PTSD among patients with heart disease and cancer, using multiple methods to determinate PTSD: the Post-Traumatic Stress Scale 10 (PTSS10), Impact of Event Scale-Revised (IES-R) and the Structured Clinical Interview for DSM-IV (SCID)
Out of the 15 patients, 14 obtained a result indicating a possibility of PTSD (14% of the entire group) based on the IES-R scales
Summary
Identification of all stressors that can cause posttraumatic stress disorder (PTSD) is a challenge for modern psychiatry. A significant number of reports have indicated a more frequent incidence of PTSD among patients with cardiac disease when compared with the general population. Most of the publications reviewed were based on self-report rating scales and did not contain evidence that the traumatic factors were directly connected with heart disease. A high level of PTSD incidence (23% vs 9% in the control group) was obtained by Bayer-Topilsky et al [3] in a study of patients with mitral regurgitation based on the PTSD Checklist – Civilian Version (PCL-C), a self-rating questionnaire. One such study [4] compared an observed prevalence of PTSD among patients with heart disease and cancer, using multiple methods to determinate PTSD: the Post-Traumatic Stress Scale 10 (PTSS10), Impact of Event Scale-Revised (IES-R) and the Structured Clinical Interview for DSM-IV (SCID). The following results were obtained for each scale: 29.2%, 7.6% and 4.8%, indicating poor compatibility between the methods [4]
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