Mary Alice Mills

Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-analytic Review

Background Acute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients’ risk for subsequent cardiac events and mortality. Objective: To determine the prevalence of PTSD induced by ACS and to quantify the association between ACS-induced PTSD and adverse clinical outcomes using systematic review and meta-analysis. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists. Methodology/Principal Findings Observational cohort studies that assessed PTSD with specific reference to an ACS event at least 1 month prior. We extracted estimates of the prevalence of ACS-induced PTSD and associations with clinical outcomes, as well as study characteristics. We identified 56 potentially relevant articles, 24 of which met our criteria (N = 2383). Meta-analysis yielded an aggregated prevalence estimate of 12% (95% confidence interval [CI], 9%–16%) for clinically significant symptoms of ACS-induced PTSD in a random effects model. Individual study prevalence estimates varied widely (0%–32%), with significant heterogeneity in estimates explained by the use of a screening instrument (prevalence estimate was 16% [95% CI, 13%–20%] in 16 studies) vs a clinical diagnostic interview (prevalence estimate was 4% [95% CI, 3%–5%] in 8 studies). The aggregated point estimate for the magnitude of the relationship between ACS-induced PTSD and clinical outcomes (ie, mortality and/or ACS recurrence) across the 3 studies that met our criteria (N = 609) suggested a doubling of risk (risk ratio, 2.00; 95% CI, 1.69–2.37) in ACS patients with clinically significant PTSD symptoms relative to patients without PTSD symptoms. Conclusions/Significance This meta-analysis suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Further tests of the association of ACS-induced PTSD and clinical outcomes are needed.

Trauma and Stress Response Among Hurricane Katrina Evacuees

OBJECTIVES Hurricane Katrinas impact on public health has been significant and multifaceted, with trauma-related psychological sequelae likely to result in a sizable burden of disease. Data were collected that assessed acute stress disorder (ASD) prevalence and factors related to ASD symptomatology among sheltered evacuees. METHODS On days 12 to 19 after Katrina, evacuees at a major emergency shelter completed surveys that assessed demographics, Katrina-specific experiences, and ASD symptomatology. RESULTS Sixty-two percent of the sample met ASD threshold criterion. Projections based on the predictive power of ASD to posttraumatic stress disorder (PTSD) suggest that 38% to 49% of the sample will meet PTSD criteria 2 years post-disaster. Female gender (odds ratio [OR] = 4.08), positive psychiatric history (OR=5.84), injury (OR=2.75), increased life-threat perception (OR=1.37), and decreased sense of personal control (OR=1.56) were significantly related to ASD. Black race was associated with greater symptom severity (B=7.85, SE[B]=3.50). CONCLUSIONS Katrina-related trauma and its psychological sequelae will remain a significant public health issue for years to come. The identification of several vulnerability factors related to ASD and PTSD provides a brief sketch of those at greatest risk.

From Shattered Assumptions to Weakened Worldviews: Trauma Symptoms Signal Anxiety Buffer Disruption

The fundamental assertion of worldview-based models of posttraumatic stress disorder (PTSD) is that trauma symptoms result when traumatic experiences cannot be readily assimilated into previously held worldviews. In two studies, we test the anxiety buffer disruption hypothesis, which states that trauma symptoms result from the disruption of normal death anxiety–buffering functions of worldviews. In Study 1, participants with trauma symptoms greater than the cutoff for PTSD evinced greater death thought accessibility than those with subclinical or negligible symptoms after a reminder of death. In Study 2, participants with clinically significant trauma symptoms showed no evidence of worldview defense though death thoughts were accessible. These results support the anxiety buffer disruption hypothesis and suggest an entirely new approach to experimental PTSD research.

Factor structure of the acute stress disorder scale in a sample of Hurricane Katrina evacuees.

Acute stress disorder (ASD) is a poorly understood and controversial diagnosis (A. G. Harvey & R. A. Bryant, 2002). The present study used confirmatory factor analysis (CFA) to test the factor structure of the most widely used self-report measure of ASD, the Acute Stress Disorder Scale (R. A. Bryant, M. L. Moulds, & R. M. Guthrie, 2000), in a sample of Hurricane Katrina evacuees relocated to a Red Cross emergency shelter in Austin, Texas. Results indicated that the proposed 4-factor structure did not fit the data well. However, an alternate 2-factor model did fit the data well. This model included a second-order Distress factor (onto which the Reexperiencing, Arousal, and Avoidance factors loaded strongly) that was positively correlated with the Dissociation factor. Implications for the ASD construct and its measurement are discussed.

The experience of intrusions scale: A preliminary examination

Abstract Intrusive thoughts (i.e., unwelcome, distressing, involuntary thoughts) are prevalent in a variety of clinical conditions and are increasingly a focus of translational research. The goal of this study was to develop and preliminarily examine a brief self-report measure designed to assess clinically relevant aspects of the experience of intrusive thoughts related to a particular target. The Experience of Intrusions Scale (EIS) is a five-item measure that assesses the frequency, unpredictability, and unwantedness of intrusive thoughts, as well as the interference and distress caused by the intrusions, each on a five-point Likert-type scale. Five times over a four-] period, female undergraduates (N=160) completed the EIS in response to intrusive thoughts regarding a film clip depicting a sexual assault. On the first and last days, participants completed the EIS five minutes after watching the clip. In between film clip viewings, participants completed the EIS once per day. The EIS demonstrated good internal consistency, good to excellent test–retest reliability using both immediate post-stimulus and 24-hour time intervals, and convergent validity with two existing measures of intrusive phenomena: the White Bear Suppression Inventory (Wegner & Zanakos, 1994) and the Post-traumatic Stress Disorder Checklist-Civilian Version (Weathers, Litz, Herman, Huska, & Keane, 1993).

Association of Posttraumatic Stress Disorder and Depression With All-Cause and Cardiovascular Disease Mortality and Hospitalization Among Hurricane Katrina Survivors With End-Stage Renal Disease

OBJECTIVES We determined the association of psychiatric symptoms in the year after Hurricane Katrina with subsequent hospitalization and mortality in end-stage renal disease (ESRD) patients. METHODS A prospective cohort of ESRD patients (n = 391) treated at 9 hemodialysis centers in the New Orleans, Louisiana, area in the weeks before Hurricane Katrina were assessed for posttraumatic stress disorder (PTSD) and depression symptoms via telephone interview 9 to 15 months later. Two combined outcomes through August 2009 (maximum 3.5-year follow-up) were analyzed: (1) all-cause and (2) cardiovascular-related hospitalization and mortality. RESULTS Twenty-four percent of participants screened positive for PTSD and 46% for depression; 158 participants died (79 cardiovascular deaths), and 280 participants were hospitalized (167 for cardiovascular-related causes). Positive depression screening was associated with 33% higher risk of all-cause (hazard ratio [HR] = 1.33; 95% confidence interval [CI] = 1.06, 1.66) and cardiovascular-related hospitalization and mortality (HR = 1.33; 95% CI = 1.01, 1.76). PTSD was not significantly associated with either outcome. CONCLUSIONS Depression in the year after Hurricane Katrina was associated with increased risk of hospitalization and mortality in ESRD patients, underscoring the long-term consequences of natural disasters for vulnerable populations.

Prospective risk factors for subsequent exposure to potentially traumatic events

Abstract In a sample of 1528 college students, we examined (1) whether several risk factors prospectively predicted exposure to potentially traumatic events (PTEs) over a 2-month period and (2) whether dependent events (i.e., those more likely to depend upon ones behavior or characteristics) and independent events were predicted by different risk factors. Logistic regression analyses indicated that overall subsequent PTE exposure was higher for women, those with more previous PTEs, and those who engaged in more binge drinking. Female gender and previous PTE exposure also predicted exposure to independent events. Subsequent dependent PTE exposure was predicted by more previous PTEs and binge drinking, and was somewhat higher in ethnic minority students. Implications for prevention efforts are discussed.

Religious Worldviews and Stressful Encounters: Reciprocal Influence from a Meaning-Making Perspective

The goal of this chapter is to explore religion and spirituality (R/S) in the context of stressful life events. In particular, we examine two primary issues: (1) how R/S influences people’s appraisal of, and coping with, both normative transitions and unexpected crises, and (2) as part of the coping process, how life transitions and crises influence individuals’ subsequent R/S. We begin with a description of the meaning-making framework of stress and coping (Park and Folkman 1997; Park 2005a) and describe how religiousness/spirituality is a central part of this framework for many people. We then use this framework to integrate theory and empirical literature on these two primary issues. The meaning-making framework is broad enough to encompass the coping challenges that are considered within both the stressful life events approach and the developmental or normative transition approach. This broader framework, therefore, includes positive events that may be stressful but that are sought after (e.g., college, marriage), as well as negative life events. While many have noted the role of religious beliefs in transforming the appraisal or interpretation of negative events (e.g., Pargament 1997), we propose that the interaction of R/S meaning systems and stressful life events is best conceptualized as an ongoing and recursive process of mutual influence (see Fig. 25-1). This chapter will examine the existing empirical research relevant to the recursivity hypothesis and conclude with suggestions for future research.