Cognitive predictors of posttraumatic stress symptoms six months following acute coronary syndrome

This study examined patients' illness representations assessed shortly after an acute coronary syndrome (ACS) as predictors of posttraumatic stress symptoms six months later. Illness representations were assessed in ACS patients using standard measures at a home visit three weeks after discharge from hospital. Posttraumatic stress symptoms were assessed at the same time, and again six months later. Patients were aged 61 years on average, the majority being men (89.8%) of white European decent (89%). Greater posttraumatic symptoms at six months were associated with beliefs that the illness would last a long time (timeline), that it had an unpredictable time course (timeline--cyclical), greater consequences, less personal and treatment control, poorer illness coherence and stronger negative emotional representations (emotional upset relating to the illness; p < 0.05). In multiple regression analyses, controlling for demographic, clinical and psychological factors (age, gender, ethnicity, social deprivation, ACS severity, negative affectivity and cardiac symptom recurrence), more intense emotional representations (β = 0.146, p = 0.041) and reduced illness coherence (β = -0.133, p = 0.029), emerged as independent predictors of posttraumatic symptom severity at six months. There was a near significant effect for personal control (β = -0.113, p = 0.058). These results demonstrate the importance of illness representations of ACS in predicting longer-term posttraumatic stress symptoms.