Posttraumatic stress disorder in the wake of heart disease: prevalence, risk factors, and future research directions

Abstract

Background: There is increasing recognition that patients after a cardiac event may be at risk of posttraumatic stress disorder (PTSD). The present article reviews studies looking at PTSD as a sequel of heart disease with a focus on prevalence, risk factors, and future research directions.

Methods: We conducted a search on PsychInfo and MEDLINE from 1980 to the present. Studies were included in the review if they looked at PTSD after a cardiac event, reported on the number of cases with PTSD, and had been published in English.

Results: We identified 25 studies that fulfilled the inclusion criteria, of which 7 reported on the follow-up of previously published studies. The prevalence of PTSD after heart disease varied from 0% to 38% across studies. PTSD has been most rigorously researched after myocardial infarction with the best-powered studies finding a prevalence rate of 15%. Studies including control groups showed that cardiac patients were at risk of developing PTSD. Risk factors included sociodemographic and psychological characteristics and aspects related to the cardiac event.

Conclusion: Despite substantial heterogeneity in the methodology of studies and differences in prevalence across studies, this review indicates that subgroups of patients are at risk of PTSD after a cardiac event. Future studies investigating PTSD as a sequel of heart disease should be more systematic, use a prospective study design with multiple assessments, and include sufficiently large samples. PTSD should not be ignored as a sequel of heart disease, given preliminary evidence that PTSD may be associated with nonadherence with medication and an increased risk of clinical adverse events.