Acute Stress Symptoms 1-2 Weeks After Stroke Predict the Subsequent Development of Post-traumatic Stress Symptoms: A Prospective Cohort Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Oct 4

PMID 37792802

Authors

David Feely

Brian Slattery

Thomas Walsh

Trish Galvin

Kate Donlon

Michelle Hanlon

Darina Gormley

Gwen-Marie Brown

Sarah Quinn

Stephanie Robinson

Conor Judge

Martin ODonnell

Kiran Sarma

Brian E McGuire

Affiliations

Soon will be listed here.

Abstract

Objective: To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later.

Design: Prospective within-groups study.

Methods: Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points.

Results: Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01).

Conclusions: The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.

References

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

Wang X, Chung M, Hyland M, Bahkeit M . Posttraumatic stress disorder and psychiatric co-morbidity following stroke: the role of alexithymia. Psychiatry Res. 2010; 188(1):51-7. DOI: 10.1016/j.psychres.2010.10.002. View

Lees R, Selvarajah J, Fenton C, Pendlebury S, Langhorne P, Stott D . Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke. 2014; 45(10):3008-18. DOI: 10.1161/STROKEAHA.114.005842. View

Shalev A, Freedman S, PERI T, BRANDES D, Sahar T, Orr S . Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998; 155(5):630-7. DOI: 10.1176/ajp.155.5.630. View

Kiphuth I, Utz K, Noble A, Kohrmann M, Schenk T . Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Stroke. 2014; 45(11):3360-6. DOI: 10.1161/STROKEAHA.113.004459. View

Larson E, Kirschner K, Bode R, Heinemann A, Goodman R . Construct and predictive validity of the repeatable battery for the assessment of neuropsychological status in the evaluation of stroke patients. J Clin Exp Neuropsychol. 2005; 27(1):16-32. DOI: 10.1080/138033990513564. View

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

Bryant R, Creamer M, ODonnell M, Silove D, McFarlane A, Forbes D . A comparison of the capacity of DSM-IV and DSM-5 acute stress disorder definitions to predict posttraumatic stress disorder and related disorders. J Clin Psychiatry. 2015; 76(4):391-7. DOI: 10.4088/JCP.13m08731. View

Nasreddine Z, Phillips N, Bedirian V, Charbonneau S, Whitehead V, Collin I . The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4):695-9. DOI: 10.1111/j.1532-5415.2005.53221.x. View

10.

Rosman L, Sico J, Lampert R, Gaffey A, Ramsey C, Dziura J . Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults: A 13-Year Cohort Study. Stroke. 2019; 50(11):2996-3003. DOI: 10.1161/STROKEAHA.119.026854. View

11.

Favrole P, Jehel L, Levy P, Descombes S, Muresan I, Manifacier M . Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study. J Neurol Sci. 2013; 327(1-2):35-40. DOI: 10.1016/j.jns.2013.02.001. View

12.

BLAKE D, Weathers F, Nagy L, Kaloupek D, Gusman F, Charney D . The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995; 8(1):75-90. DOI: 10.1007/BF02105408. View

13.

Kronish I, Edmondson D, Goldfinger J, Fei K, Horowitz C . Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks. Stroke. 2012; 43(8):2192-7. PMC: 3404197. DOI: 10.1161/STROKEAHA.112.655209. View

14.

Goldfinger J, Edmondson D, Kronish I, Fei K, Balakrishnan R, Tuhrim S . Correlates of post-traumatic stress disorder in stroke survivors. J Stroke Cerebrovasc Dis. 2013; 23(5):1099-105. PMC: 3992186. DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.019. View

15.

Brewin C, Andrews B, Rose S, Kirk M . Acute stress disorder and posttraumatic stress disorder in victims of violent crime. Am J Psychiatry. 1999; 156(3):360-6. DOI: 10.1176/ajp.156.3.360. View

16.

Bryant R, Moulds M, Guthrie R . Acute Stress Disorder Scale: a self-report measure of acute stress disorder. Psychol Assess. 2001; 12(1):61-8. View

17.

Brewin C, Dalgleish T, Joseph S . A dual representation theory of posttraumatic stress disorder. Psychol Rev. 1996; 103(4):670-86. DOI: 10.1037/0033-295x.103.4.670. View

18.

Govan L, Langhorne P, Weir C . Categorizing stroke prognosis using different stroke scales. Stroke. 2009; 40(10):3396-9. DOI: 10.1161/STROKEAHA.109.557645. View

19.

Aben I, Verhey F, Lousberg R, Lodder J, Honig A . Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients. Psychosomatics. 2002; 43(5):386-93. DOI: 10.1176/appi.psy.43.5.386. View

20.

Chun H, Whiteley W, Dennis M, Mead G, Carson A . Anxiety After Stroke: The Importance of Subtyping. Stroke. 2018; 49(3):556-564. PMC: 5839706. DOI: 10.1161/STROKEAHA.117.020078. View