Posttraumatic Stress Disorder and the Nature of Trauma in Patients with Cardiovascular Diseases: A Case-Control study

Introduction A large body of evidence indicates a significant and morbid association between posttraumatic stress disorder (PTSD) and cardiovascular disease (CVD). Few studies, however, have addressed the range of trauma in this medical population, from massive heart attack, to defibrillator shock to previous interpersonal aggression. Objective The main objective of this study was to examine the nature of trauma associated with the development of PTSD in CVD patients. More precisely, we were interested in knowing if trauma was medical in nature and whether cumulative trauma resulted in PTSD. Methods We performed a 1:3 case-control study. The authors compared CVD patients diagnosed with PTSD (n=37) to those with adjustment disorder (n=111) in terms of trauma/stressor types and medical and demographic characteristics. Results Half (51%) of CVD patients suffering from PTSD had endured a medical trauma, 35% an external (non-medical) trauma, and 14% both. There were no significant differences with CVD patients diagnosed with adjustment disorder, 40% of them having experienced a medical stressor, 40% an external (non-medical) stressor and 20% both. Cumulative trauma was seen in only 19% of CVD patients suffering from PTSD. Traditional risk factors (female sex, younger age) were not prominent in CVD patients with PTSD as compared to those with adjustment disorder. Cases were, however, significantly more likely to have psychiatric antecedents and recent surgical interventions. Conclusions By uncovering characteristics of PTSD patients/trauma in CVD patients, this work will serve future research and clinical initiatives to better screen at-risk patients or at-risk medical situations.