Trajectories of posttraumatic stress disorder following myocardial infarction: a prospective study. When a PTSD (posttraumatic stress) questionnaire was given to 112 consecutive heart attack patients 4 to 6 weeks after their first infarction, as well as to 115 healthy controls selected randomly from the general population, researchers from Tilburg University in The Netherlands found that people were three times as likely to develop the disorder after their first heart attack. Twenty-five patients (22%) qualified for a diagnosis of posttraumatic stress disorder (PTSD), as compared with 8 controls (7%). After adjusting for other variables, the risk was reduced to above a two-fold risk (OR: 2.71; 95% CI: 0.99-7.41).

Citation: Pedersen SS, Middel B, Larsen ML. Posttraumatic stress disorder in first-time myocardial infarction patients. Heart Lung. 2003 Sep-Oct; 32 (5): pp.300-7. Investigators at The Bob Shapell School of Social Work, Tel Aviv University, Israel, examined the incidence of posttraumatic stress disorder (PTSD) following MI (myocardial infarction, or heart attack), to tease out predictors of PTSD. The study looked at variables such as the level of threat, the nature of the patient’s initial reactions, patient somatization, health-related quality of life, and whether or not there had been re-hospitalization in the 7 months following the MI.

One hundred sixteen MI patients were examined twice, first, within a week of their MI, and again, 7 months later. Acute stress disorder (ASD) was assessed the first time, along with medical measures obtained from patients'' hospital records. At the 7 month interval, scores were obtained for PTSD, anxiety, physical residuals, and health-related quality of life.

Six percent of the respondents were found to have both ASD and PTSD; 10% did not have ASD but did acquire PTSD; and 12% had ASD but not PTSD. (In other words, at 7 months, 16% were found to have PTSD.) The trajectory of PTSD was associated with severity of anxiety, somatic complaints, and health-related quality of life. In addition, while the severity of MI did not predict the trajectory of PTSD, the perceived severity did. Patients without PTSD but with prior ASD did not differ in their initial reactions from those without ASD.

These findings provide support for the considerable variability in the trajectory of the development of PTSD and suggest that although ASD is associated with subsequent PTSD, the predictive role of initial reactions is limited.

Citation: Ginzburg K, Solomon Z, Koifman B, Keren G, Roth A, Kriwisky M, Kutz I, David D, Bleich A. Trajectories of posttraumatic stress disorder following myocardial infarction: a prospective study. Journal of Clinical Psychiatry. 2003 Oct; 64 (10): pp. 1217-23. Israel. [email protected]