Predictors of posttraumatic stress following transient ischemic attack: An observational cohort study

Abstract

Objective: Transient ischemic attack (TIA) has been reported to be frequently followed by symptoms of post-TIA posttraumatic stress disorder (post-TIA PTSD). Risk factors for post-TIA PTSD remain largely unknown. We aimed to identify predictors of post-TIA PTSD development to enable post-TIA PTSD risk assessment and inform future development of treatment and prevention interventions.

Method: TIA patients were examined twice for this observational cohort study. Symptoms of post-TIA PTSD, depression and anxiety were assessed shortly after TIA during in-hospital stay (T₁) and three months after TIA (T₂). The impact of known general PTSD risk factors (psychiatric history, peritraumatic dissociation, social support), psychological resilience factors (sense of coherence, mindfulness, attachment style) and TIA characteristics (affected circulatory territory, symptom type and duration) at T₁ on post-TIA PTSD symptom severity at T₂ was tested using hierarchical multiple linear regression.

Results: Sixty-one patients (83.6%) completed the study at T₂. Fifteen patients (24.6%) were classified as post-TIA PTSD⊕ at T₂. In multiple linear regression analysis, age, sex, psychiatric history, peritraumatic dissociation and social support together explained 39.9% of variance of post-TIA posttraumatic stress symptom severity. Sense of coherence and mindfulness explained further 17.8% of variance. Clinical TIA characteristics were not associated with post-TIA PTSD.

Conclusions: Post-TIA PTSD is a common phenomenon. General PTSD risk factors can be applied for post-TIA PTSD risk assessment. Sense of coherence and mindfulness are promising target variables for post-TIA PTSD treatment and prevention interventions.

Keywords: Ischemic attack, transient (TIA); Mindfulness; Resilience, psychological; Sense of coherence; Social support; Stress disorder, post-traumatic (PTSD).