Poststroke Post-Traumatic Stress Disorder: A Review.

Abstract

Despite a recent decline in mortality,1 cerebrovascular disease (stroke) remains the fifth leading cause of death in the United States and the leading preventable cause of disability.2 Furthermore, quality of life (QOL) after stroke depends on more than retention of physical functioning and ability.3 Psychological health and well-being are known to associate with QOL outcomes,4 for example, an estimated 30% of stroke survivors develop depression.5 Although poststroke depression (PSD) is a well-researched and established phenomenon,6–8 far less is known about the development of poststroke post-traumatic stress disorder (PTSD).9 Researchers have hypothesized that acute medical conditions such as asthma attack10 and myocardial infarction11 can precipitate PTSD, but PTSD specifically after a stroke has only been formally conceptualized for <2 decades.12 Despite the relative paucity of research on post-stroke PTSD, this article attempts to consolidate what is currently known: elaborating on the construct of poststroke PTSD, weighing the conflicting prevalence reports in the literature, exploring identified or hypothesized pre-morbid and post-morbid predicting factors, and summarizing promising future directions for research. Identifying gaps or conflicting findings may facilitate future studies to identify risk factors for poststroke PTSD and establish a more efficacious management strategy. Stroke is one of the leading causes of disability in adults.2 With estimated prevalence rates of 20% to 65%, depression is a pervasive consequence of stroke that has been linked to cognitive deficits including memory, nonverbal problem solving, attention, and psychomotor speed.13 Likewise, depressive symptoms experienced up to 12 months after hospitalization for subarachnoid hemorrhage (SAH) are tightly associated with QOL, more so than both demographic variables and hemorrhage severity.14 But PSD is not the only mental health outcome that may follow stroke; poststroke PTSD has similarly been shown to impact mental health and …