Posttraumatic Stress Symptoms In Patients Research Articles

Post-traumatic stress disorder and post-traumatic stress symptoms in patients with systemic autoimmune diseases during the COVID-19 pandemic.

The COVID-19 outbreak led to an increase in mental disorders, particularly post-traumatic stress disorder (PTSD), in the general population and especially in high-risk populations such as patients with rheumatologic conditions. Although these latters are considered vulnerable to developing PTSD, few specific data have been particularly reported in the framework of the pandemic. The aim of the present study was to investigate PTSD and post-traumatic stress symptoms (PTSS) in a sample of patients with systemic autoimmune disease (SAD), followed in the framework of a prospective observational study during the pandemic. The PERMAS project is a prospective observational study including patients with SAD and involving the Rheumatology and the Psychiatric Clinics of the Azienda Ospedaliero Universitaria Pisana (AOUP, Pisa, Italy) and the Institute of Management of the Scuola Superiore Sant'Anna (Pisa, Italy). The assessments included: a data-sheet for sociodemographic and clinical characteristics; the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), for PTSD and PTSS; the 36-item Short Form Survey (SF-36) to assess quality of life. The total sample consisted of 252 patients with SAD, including 131 with connective tissue disease, 101 with arthritis and 20 with systemic vasculitis. The diagnostic groups differed significantly in age (p<0.001), gender (p<0.001), prevalence of full-blown and partial PTSD (p=0.001), and other psychopathologic variables. Connective tissue disease and SF-36 were significantly associated with the TALS-SR scores in both univariate (p<0.001) and multivariate (p<0.025; p<0.001) analyses. Patients with SAD, and, in particular, patients with connective tissue diseases reported an increased risk of developing stress-related psychopathological symptoms, indicating the need for special psychological monitoring of this high-risk group.

Posttraumatic Stress Symptoms in Patients With Cancer During the COVID-19 Pandemic: A One-Year Longitudinal Study.

Patients with cancer may be particularly vulnerable to psychological consequences of the COVID-19 pandemic. We studied the prevalence and evolution of posttraumatic stress symptoms (PTSS) in patients with cancer during the pandemic waves, and we investigated factors associated with high symptoms. COVIPACT is a 1-year longitudinal prospective study of French patients with solid/hematologic malignancies receiving treatment during the first nationwide lockdown. PTSS were measured every 3 months from April 2020 using the Impact of Event Scale-Revised. Patients also completed questionnaires on their quality of life, cognitive complaints, insomnia, and COVID-19 lockdown experience. Longitudinal analyses involved 386 patients with at least one PTSS assessment after baseline (median age, 63 years; 76% female). Among them, 21.5% had moderate/severe PTSS during the first lockdown. The rate of patients reporting PTSS decreased at lockdown release (13.6%), increased again at second lockdown (23.2%), and slightly declined from the second release period (22.7%) to the third lockdown (17.5%). Patients were grouped into 3 trajectories of evolution. Most patients had stable low symptoms throughout the period, 6% had high baseline symptoms slowly decreasing over time, and 17.6% had moderate symptoms worsening during the second lockdown. Female sex, feeling socially isolated, worrying about COVID-19 infection, and using psychotropic drugs were associated with PTSS. PTSS were associated with impaired quality of life, sleep, and cognition. Approximately one-fourth of patients with cancer experienced high and persistent PTSS over the first year of the COVID-19 pandemic and may benefit from psychological support. gov identifier: NCT04366154.

Genetic variants associated with post-traumatic stress symptoms in patients with gynecologic cancer

ObjectivePatients with cancer experience symptoms of post-traumatic stress disorder (PTSD) more commonly than the general population. The objective of this study was to identify single nucleotide polymorphisms (SNPs) associated with increased risk of post-traumatic stress disorder (PTSD) in patients with gynecologic cancer. MethodsA prospective cohort study recruited 181 gynecologic cancer survivors receiving care at the University of Minnesota between 2017 and 2020 who completed PTSD DSM-V surveys to self-report their symptoms of PTSD and provided saliva samples. DNA samples were genotyped for 11 SNPs in 9 genes involved in dopaminergic, serotonergic, and opioidergic systems previously associated with risk of PTSD in populations without cancer. ResultsMost participants had either ovarian (42.5%) or endometrial (46.4%) cancer; fewer had cervical (7.7%) or vaginal/vulvar (3.3%) cancer. Two SNPS were identified as statistically significantly associated with higher PTSD scores: rs622337 in HTR2A and rs510769 in OPRM1. ConclusionsGenetic variation likely plays a role in development of PTSD. HTR2A is involved in the serotonin pathway, and OPRM1 is involved in the opioid receptor pathway. This information can be used by oncologic providers to identify patients at greater risk of developing PTSD and may facilitate referral to appropriate consultants and resources early in their treatment.

Lung Cancer and Posttraumatic Stress Symptoms

Objective: Lung cancer is the most common cancer and the leading cause of cancer death worldwide. Research on the correlation between posttraumatic stress symptoms (PTSSs) and lung cancer is limited. In this study, we intended to study PTSS predictors in patients with lung cancer and their subgroups. Methods: Patients aged ≥ 20 years with lung cancer diagnosis were recruited. We collected information on demographic characteristics, depressive symptoms, and cognitive function, to examine the effect on PTSSs. With the Chinese version of the startle, physiological arousal, anger, and numbness questionnaire, we analyzed the variables to identify the independent correlates of PTSSs and to compare differences among treatment and cancer stage subgroups. Results: A total of 329 lung cancer patients were included with prominent male, below senior high school education level, married status, unemployment, smoking history, non-alcohol drinker, without psychiatric history and comorbid diabetes and hypertension. The correlates of PTSSs were significantly higher in education level (β = 0.197, p &lt; 0.01), cognitive function (β = −0.269, p &lt; 0.001), and depressive symptoms (β = 0.294, p &lt; 0.001). In subgroup analysis, high education level was significantly correlated of PTSSs in different treatment groups surgery group (β = 0.266, p &lt; 0.05), nonsurgery group (β = 0.204, p &lt; 0.05), chemotherapy group (β = 0.189, p &lt; 0.05), and nonchemotherapy group (β = 0.220, p &lt; 0.05). Cognitive function was significantly correlated of PTSSs in different cancer stages in early stage (β = −0.401, p &lt; 0.01) and advanced stage (β = −0.182, p &lt; 0.05). Conclusion: Depressive symptoms, high education level, and the poor cognitive function were significantly associated with PTSSs in patients with lung cancer. Health professionals in oncology should consider psychological burden screening, cognitive function examination, and rehabilitation in clinical practice.

Post-traumatic stress symptoms in COVID-19 survivors: a self-report and brain imaging follow-up study.

Previous coronavirus pandemics were associated elevated post-traumatic stress symptoms (PTSS), but the self-report and neurological basis of PTSS in patients who survived coronavirus disease 2019 (COVID-19) are largely unknown. We conducted a two-session study to record PTSS in the COVID-19 survivors discharged from hospitals for a short (i.e., about 3 months, Session 1) to a medium period (i.e., about 6 months, Session 2), as well as brain imaging data in Session 2. The control groups were non-COVID-19 locals. Session 1 was completed for 126 COVID-19 survivors and 126 controls. Session 2 was completed for 47 COVID-19 survivors and 43 controls. The total score of post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) score was significantly higher in COVID-19 survivors compared with controls in both sessions. The PCL-5 score in COVID-19 survivors was positively correlated with the duration after discharge (r = 0.27, p = 0.003 for Session 1), and increased by 20% from Session 1 to Session 2 for the survivors who participated both sessions. The increase was positively correlated with individual’s test-retest duration (r = 0.46, p = 0.03). Brain structural volume and functional activity in bilateral hippocampus and amygdala were significantly larger in COVID-19 survivors compared with controls. However, the volumes of the left hippocampus and amygdala were negatively correlated with the PCL-5 score for the COVID-19 survivors. Our study suggests that COVID-19 survivors might face possible PTSS deteriorations, and highlights the importance of monitoring mental wellness of COVID-19 survivors.

Posttraumatic Stress in Patients With Inflammatory Bowel Disease: Prevalence and Relationships to Patient-Reported Outcomes.

BackgroundPatients with chronic illness are at increased risk for traumatic stress because of medical trauma. Initial studies of posttraumatic stress (PTS) in patients with inflammatory bowel disease (IBD) have found that approximately one-third of patients may experience significant PTS symptoms including flashbacks, nightmares, hypervigilance, disrupted sleep, and low mood. We aim to better characterize PTS in IBD and its relationship with patient outcomes in a large cohort of patients with IBD.MethodsAdult patients registered with the Crohn’s & Colitis Foundation/University of North Carolina IBD Partners database were invited to complete a supplementary survey between February and July 2020. The Post Traumatic Stress Disorder Checklist-5th edition was administered as a supplemental survey. Additional data from IBD Partners included disease severity, surgery and hospital history, demographics, and health care utilization.ResultsA total of 797 patients participated (452 with Crohn disease, 345 with ulcerative colitis). No impacts on response patterns because of the COVID-19 pandemic were found. Although 5.6% of the sample reported an existing PTS diagnosis because of IBD experiences, 9.6% of participants met the full IBD-related PTS diagnostic criteria per the Post Traumatic Stress Disorder Checklist-5th edition. Female patients, younger patients, those with less educational attainment, non-White patients, and Hispanic patients reported higher levels of PTS symptoms. Patients with higher PTS symptoms were more likely to have been hospitalized, have had surgery, have more severe symptoms, and not be in remission. Increased PTS was also associated with increased anxiety, depression, pain interference, fatigue, and health care utilization.ConclusionsThe present findings support prior research that approximately one-quarter to one-third of patients with IBD report significant symptoms of PTS directly from their disease experiences, and certain demographic groups are at higher risk. In addition, PTS is associated with several IBD outcomes. Patients with higher PTS symptoms are less likely to be in remission and may utilize more outpatient gastrointestinal services. Intervention trials to mitigate PTS symptoms in patients with IBD are warranted.

Myocardial infarction-induced acute stress and post-traumatic stress symptoms: the moderating role of an alexithymia trait – difficulties identifying feelings

ABSTRACT Background It has been acknowledged that medical life-threatening experiences such as an acute myocardial infarction (MI) often lead to acute stress disorder symptoms (ASS), which in turn can result in the development of post-traumatic stress symptoms (PTSS). Previous studies have suggested an association between various traumatic experiences and alexithymia. The association of alexithymia with ASS and PTSS in patients with MI is elusive. Objectives The aim of this study was to examine the association of alexithymia with MI-induced ASS and PTSS in patients at high risk of developing PTSD. Method Patients (N = 154) were examined twice, once within 48 hours, and then again three months after acute MI. All patients completed the self-rating Acute Stress Disorder Scale (ASDS) within 48 hours after the cardiac event. Three months after hospital discharge, all patients completed the Toronto Alexithymia Scale (TAS-20) and underwent the Clinician-Administered PTSD Scale (CAPS), a structured interview to assess the severity of PTSS. Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted. Results The linear regression model explained 23% of the variance in MI-induced PTSS-symptoms (F(6.109) = 5.58, p < 0.001, R 2 = 0.23. ASS was significantly related to PTSS severity (r (152) = p < 0.001). The scores of the TAS-20 subscale difficulties identifying feelings (DIF) were found to significantly moderate this relationship (R2 = 0.03, p = 0.04). The scores of TAS-20 subscales DDF and EOT as well as the TAS-20 total score had no influence on the relationship between ASS and PTSS (p > 0.05). Conclusion In MI patients with high levels of DIF, ASS predicted the development of PTSS. If replicated, the finding may inform emotion-oriented interventions to investigate whether increasing the capacity to identify feelings following acute MI could be beneficial in preventing the development of PTSS.

Baseline Resilience and Posttraumatic Symptoms in Dyads of Neurocritical Patients and Their Informal Caregivers: A Prospective Dyadic Analysis

Admission to a neuroscience intensive care unit (Neuro-ICU) is sudden and often traumatic for both patients and their informal caregivers. No prior studies have assessed prospectively risk and resiliency factors for chronic posttraumatic symptoms, as well as the potential interdependence between patients' and caregivers' symptoms over time. To analyze the impact of baseline resiliency factors on symptoms of posttraumatic stress (PTS) longitudinally in dyads of patients admitted to the Neuro-ICU and their primary family caregivers. We recruited dyads (M= 108) of patients admitted to the Neuro-ICU (total N=102) and their family caregivers (total N=103). Dyads completed self-report assessments of PTS and resiliency factors (mindfulness and coping) at baseline in the Neuro-ICU. PTS was measured again at 3- and 6-month follow-up. Clinically significant PTS symptoms were high at baseline in both patients (20%) and caregivers (16%) and remained high through 6 months (25% in patients; 14% in caregivers). Actor-partner interdependence modeling demonstrated that severity of PTS symptoms was predictive of PTS symptoms at subsequent time points (P<0.001). High baseline mindfulness and coping predicted less severe PTS symptoms in patients and caregivers (P<0.001) at all time points. Own degree of PTS symptoms at 3 months predicted worse PTS symptoms in one's partner at 6 months, for both patients and caregivers (P= 0.02). Findings highlight the need to prioritize assessment and treatment of PTS in Neuro-ICU patients and their informal caregivers through a dyadic approach.

Correlations And Correlates Of Post-Traumatic Growth And Post-Traumatic Stress Symptoms In Patients With Breast Cancer.

PurposeAlthough post-traumatic growth (PTG) and post-traumatic stress symptoms (PTSS) might develop and coexist after a major trauma, few studies have simultaneously examined them in patients with breast cancer. This study investigated the correlation between PTG and PTSS and their differential correlates in patients with breast cancer.Patients and methodsOverall, 145 patients with breast cancer were recruited. PTG and PTSS were assessed using the PTG inventory and the Chinese version of startle, physiological arousal, anger, and numbness, respectively. We investigated the effects of demographics, chemotherapy, depression, family support, alexithymia, and anxiety symptoms on PTG and PTSS. Multivariate linear regression analyses were performed to select the independent correlates of PTSS and PTG.ResultAn association was observed between PTG and PTSS (r = 0.21). Based on multiple regression models, the common correlate of PTG (β = 0.271) and PTSS (β = 0.212) was anxiety symptoms. Differential independent correlates were years of education (β = 0.272), receiving chemotherapy (β = 0.248), and family support (β = 0.259) for PTG, and chronic pain (β = 0.316) and poor cognition (β = −0.350) for PTSS.ConclusionDifferential correlates were observed for PTG and PTSS in patients with breast cancer. Possible mechanisms and relationships between PTG and PTSS were discussed.

The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers.

Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan. The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers. A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects' scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables. There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression. The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression. Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.

Sex and spouse conditions influence symptoms of anxiety, depression, and posttraumatic stress disorder in both patients admitted to intensive care units and their spouses.

ObjectivesTo assess the effect of sex and spouse condition on symptoms of anxiety, depression and posttraumatic stress symptoms in patients and their spouses.MethodsA prospective study conducted in a 22-bed adult mixed intensive care unit in a tertiary hospital in São Paulo, Brazil. Patients and their spouses were enrolled 2 days after intensive care unit admission. They were interviewed while in the intensive care unit using the Hospital Anxiety and Depression Scale. At 30 and 90 days after intensive care unit discharge, they completed the Impact of Event Scale and Hospital Anxiety and Depression Scale by phone.ResultsFrom March 2011 to March 2013, we analyzed 118 patients and their spouses. We observed that female sex was associated with higher scores than male sex was in terms of the anxiety Hospital Anxiety and Depression Scale - subscale (p = 0.032) and depression (p = 0.034). There was no association between sex and posttraumatic stress disorder symptoms. However, spouses had higher Impact of Event Scale points compared with patients (p = 0.001).ConclusionsFemale sex was associated with anxiety and depression, and spouses were more vulnerable to post-traumatic stress symptoms than the patients were. Increasing age and a later time of assessment were also associated with lower scores on the Impact of Event Scale.

Detection of Posttraumatic Stress Symptoms in Patients After Discharge From Intensive Care.

Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. To examine the feasibility and acceptability of a screening tool to detect posttraumatic stress syndrome, screen for the syndrome soon after discharge from intensive care to identify patients at risk for post-traumatic stress disorder, and determine personal and clinical factors related to higher scores on the screening instrument. A single-center, cross-sectional design was used. At 2 to 4 weeks after hospital discharge, 41 patients treated in an intensive care unit completed the screening instrument and the Screening Experience Questionnaire via telephone. Associations between participants' characteristics and scores were examined, and screening experiences were described. Participants reported that the screening instrument was easy to understand, caused little distress, and could be completed in an acceptable time frame. Participants reported that they had not been screened via a formal process or received education during or after their stay in the unit. Among the participants, 44% preferred screening in the outpatient setting. Higher scores on the screening tool were associated with history of depression, moderate levels of sedation, and intensive care unit delirium. The majority of intensive care patients most likely are not being screened for posttraumatic stress syndrome despite a higher risk for the syndrome in these patients than in the general population.

Cancer-Related Posttraumatic Stress Symptoms in Patients With Cancer

At least half of patients with cancer experience emotional distress (e.g., posttraumatic stress symptoms). Most of the studies on the emotional distress of Taiwanese cancer patients have focused on issues of depression rather than on posttraumatic stress disorder. The scope of the present article covers the definitions of cancer-related posttraumatic stress disorder (CR-PTSD) and cancer-related posttraumatic stress symptoms (CR-PTSS), identifies the differences and similarities between professional interview and self-administered measurement tools and their applications; analyzes the prevalence of CR-PTSD and CR-PTSS; identifies the possible contributing sociodemographic (younger age, female, low education, low socio-economic status), clinical (advanced stage, undergoing chemotherapy, just completed the therapy), and psychosocial (negative psychological traits, poor social support, and insufficient coping strategies) of CR-PTSD and CR-PTSS; and aggregates the effects of cognitive and psychosocial interventions on CR-PTSD and CR-PTSS. Furthermore, recommendations for clinical practice and research are discussed. This article is expected to provide practicing nurses with a basic concept of caring for emotional distress and to inspire researchers to conduct further study of issues related to CR-PTSD and CR-PTSS.

The fear of dying and occurrence of posttraumatic stress symptoms after an acute coronary syndrome: A prospective observational study.

The purpose of the study was to investigate whether experiencing fear of dying after acute coronary syndrome predicts later posttraumatic stress symptoms. We enrolled 90 patients hospitalized with main diagnosis of acute coronary syndrome and assessed baseline characteristics. One month after discharge, we collected the Posttraumatic Stress Scale. A total of 24 patients (26.7%) developed posttraumatic stress symptoms 1 month after the acute coronary syndrome event. Patients with posttraumatic stress symptoms reported significantly greater fear of dying, helplessness, avoidance-focused coping, and severe anxiety. In our prospective study, fear of dying was associated with occurrence of posttraumatic stress symptoms in patients hospitalized with acute coronary syndrome.

Perceived clinician-patient communication in the emergency department and subsequent post-traumatic stress symptoms in patients evaluated for acute coronary syndrome.

Evaluation for a potentially life-threatening cardiac event in the emergency department (ED) is a stressful experience that can result in symptoms of post-traumatic stress disorder, which are associated with increased risk of morbidity and mortality in patients. No study has tested whether good clinician-patient communication in the ED is associated with better psychological outcomes in these individuals and whether it can mitigate other risk factors for post-traumatic stress symptoms (PSS) such as perception of life threat and vulnerability in the ED. Data were analysed from 474 participants in the Reactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected acute coronary syndrome. Participants were recruited from November 2013 to January 2015 at a single-site academic medical centre (New York-Presbyterian-Columbia University Medical Center). Participants reported threat perceptions in the ED and provided information on their perceptions of clinician-patient communication using the Interpersonal Process of Care Survey. PSS were assessed using the Acute Stress Disorder Scale during follow-up. 474 subjects were enrolled in the study. Median length of follow-up was 3 days after ED presentation, range 0-30 days, 80% within 8 days. Perceptions of good clinician-patient communication in the ED were associated with lower PSS, whereas increased threat perception was associated with higher PSS. A significant interaction between clinician-patient communication and threat perception on PSS suggested that patients with higher threat perception benefited most from good clinician-patient communication. Our study found an association between good clinician-patient communication in the ED during evaluation of potentially life-threatening cardiac events and decreased subsequent post-traumatic stress reactions. This association is particularly marked for patients who perceive the greatest degree of life threat and vulnerability during evaluation.

Körperliche und psychische Langzeitfolgen nach intensivmedizinischer Behandlung einer schweren Sepsis bei Patienten und Angehörigen

This study aimed at investigating the physical and mental long-term sequelae in survivors of severe sepsis and in their relatives. Furthermore, the role of resilience as protective factor was examined. We contacted all persons who had requested free of charge advice from the German Sepsis Aid's National Helpline and asked them to answer a questionnaire. We included 87 patients and 90 relatives of patients who survived a severe sepsis. About two thirds of the patients and relatives reported clinically relevant post-traumatic symptoms. There were strong dyadic relations between patient and spouses regarding physical and mental health and quality of life. Resilience was found to be a significant negative predictor of physical complaints, anxiety, depression and post-traumatic stress symptoms in patients and relatives. Diagnosis and therapy of mental disorders is of particular importance within primary care following sepsis.

Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge

IntroductionTo study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.MethodsOf 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was ≥ 35. Case level of HADS-Anxiety or Depression was ≥ 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.ResultsMean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES ≥ 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in posttraumatic stress, anxiety or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of posttraumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.ConclusionsThe mean level of posttraumatic stress symptoms in patients one year following ICU treatment was high and one of four were above case level Predictors of posttraumatic stress symptoms were mainly demographics and experiences during hospital stay whereas clinical injury related variables were insignificant. Pessimism was a predictor of posttraumatic stress, anxiety and depression symptoms. A subgroup of patients developed clinically significant distress symptoms during the follow-up period.

Persistence of Posttraumatic Stress Symptoms 12 and 36 Months After Acute Coronary Syndrome

To assess the prevalence and predictors of posttraumatic stress symptoms in patients at 12 and 36 months post hospital admission for an acute coronary syndrome (ACS). There is increasing recognition that posttraumatic stress may develop in the aftermath of an acute cardiac event. However, there has been little research on the longer-term prevalence of posttraumatic stress disorder (PTSD). Posttraumatic stress symptoms were assessed at 12 months in 213 patients with ACS and in 179 patients at 36 months. Predictor variables included clinical, demographic, and emotional factors measured during hospital admission. At 12 months post ACS, 26 (12.2%) patients qualified for a diagnosis of PTSD; 23 (12.8%) patients were identified with PTSD at 36 months. Posttraumatic symptoms at 12 months were associated with younger age, ethnic minority status, social deprivation, cardiac symptom recurrence, history of depression, depressed mood during admission, hostility, and Type D personality. In multiple regression, depressed mood during admission and recurrent cardiac symptoms were independent predictors of posttraumatic symptoms (R(2) = 0.507, p < .001). At 36 months, posttraumatic stress symptoms were independently predicted by posttraumatic symptom levels at 12 months and depressed mood during admission (R(2) = 0.635, p < .001). Posttraumatic stress symptoms persist for at least 3 years after an acute cardiac event. Early emotional responses are important in predicting longer-term posttraumatic stress. It is important to identify patients at risk for posttraumatic stress as they are more likely to experience reduced quality of life.

Symptoms of post‐traumatic stress in children with cancer and their parents: Effects of informant and time from diagnosis

Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustment of children with cancer and their parents, but findings in the literature regarding the prevalence of post-traumatic stress symptoms (PTSS) have been mixed. This study examined PTSS levels in both patients and parents as a function of time elapsed from diagnosis, and by use of parent versus child reports for assessing patient PTSS. Four groups of patients (total N = 162) differing in time elapsed since diagnosis were assessed with standardized measures of PTSS. Patients reported on their own symptoms, while parents reported on their symptoms as well as symptoms in their child. Significant differences between groups were observed on all patient PTSS measures. Recently diagnosed patients obtained higher PTSS scores than survivors more than 5 years from diagnosis. Likewise, parents of recently diagnosed patients self-reported significantly higher levels of PTSS than parents of long-term survivors. Parent-child correlations were high and no differences were observed between parent and patient report of patient PTSS. Comparison with historical control data suggests that levels of PTSS in patients are very low. Concordance between parent and child reports of child PTSS suggests that data may be obtained with reasonable confidence from either if only one informant is available. Higher levels of PTSS in patients who are recently diagnosed (and their parents) in comparison to long-term survivors, suggest that the symptoms reported reflect primarily a concurrent response to ongoing acute stressors, rather than a post-traumatic re-experiencing of past traumas. This, in combination with the low levels of patient PTSS raise questions regarding the utility of PTSD as a model for understanding patient and parent adjustment to childhood cancer.

Dissociation and Posttraumatic Stress Symptoms in Patients With Chronic Pain

The present study examined the number and frequency of dissociative experiences reported by patients with chronic pain and the association between dissociation and emotional distress in this population. The mean Dissociative Experiences Scale (DES) score obtained by patients with chronic pain was comparable to mean DES scores obtained by persons diagnosed with affective disorders, eating disorders, personality disorders, and schizophrenia. Based on their median DES score, patients with chronic pain reported more frequent dissociation than did normal adults and persons diagnosed with alcohol use disorders, specific phobias, and agoraphobic avoidance. Traumatized patients with chronic pain evidenced significantly more frequent dissociation than did nontraumatized patients, the traumatized group reporting dissociative experiences as occurring 17% of the time and the nontraumatized group reporting dissociative experiences as occurring 11% of the time. DES absorption, depersonalization, and amnesia scores accounted for 21% of the variance in posttraumatic stress symptoms reported by patients with chronic pain. Findings are discussed in terms of their implications for assessment and cognitive–behavioral management of traumatic stress responding in persons with chronic pain.