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Treatment rates for PTSD and depression in recently hospitalized cardiac patients

https://doi.org/10.1016/j.jpsychores.2016.05.007Get rights and content

Highlights

  • PTSD and depression are common after evaluation for suspected acute coronary syndrome (ACS).

  • Research on treatment rates for subsequent emotional distress after discharge for ACS is lacking.

  • Findings suggest 1 in 4 patients with PTSD and/or depression report receiving treatment after ACS.

Abstract

Objective

Posttraumatic stress disorder (PTSD) and depression are common after evaluation for suspected acute coronary syndrome (ACS), and are associated with poor prognosis. However, it is unclear whether patients discharged after suspected ACS access treatments for subsequent psychological distress. We examined self-reported rates of receiving psychotherapy and/or medication for psychological distress in patients one month after a suspected ACS event.

Methods

A sample of 448 adults (age 60.4 ± 12.5; 47.8% female; 52.7% Hispanic, 32.1% Black) presenting to the emergency department with suspected ACS were recruited for the REactions to Acute Care and Hospitalization (REACH) study, an ongoing cohort study of medical and psychological outcomes after ACS evaluation. Socio-demographics and depressive symptoms were assessed in-hospital, and PTSD symptoms related to the suspected ACS event were queried via phone one month after enrollment. Participants also indicated whether they received either medication or counseling to deal with their emotions and coping after their heart problem.

Results

Approximately 15% (n = 68) of the sample reported receiving some form of treatment. Treatment rate did not differ significantly as a function of demographics, ACS status, or insurance coverage, ps > 0.1. Over a quarter of participants (25.3%) who screened positive for PTSD and/or depression reported receiving treatment. Participants with PTSD and depression had a higher treatment rate (47.6%) vs. those with only depression (12.8%) or PTSD (30%) or no psychopathology (10.3%).

Conclusion

Findings suggest that 1 in 4 patients who screened positive for PTSD and/or depression reported receiving counseling or medication in the first month after a suspected ACS event.

Introduction

Posttraumatic stress disorder (PTSD) and depression are associated with both incident and recurrent cardiovascular events and mortality [2], [3], [9], [13], and both are common after acute coronary syndrome (ACS) events. Approximately 12% of ACS patients develop PTSD due to the event [2], and 20% are depressed [4]. Established psychotherapeutic and pharmacological treatments exist [6], [8], but it is unclear whether patients discharged after suspected ACS events access them. Although information on mental health treatment rates for cardiac patients is generally lacking in the literature, the extant evidence suggests that psychological conditions like depression and PTSD are generally undertreated. For example, in one study of cardiac patients, only 11% of those with depression received appropriate treatment with antidepressants [7]. Furthermore, findings from the broader PTSD literature suggest that over 50% of individuals with PTSD that develops in response to a variety of traumas never receive treatment [11]. In particular, treatment rates may be low among low socioeconomic status (SES), racial/ethnic minority patients [5], [11]. We examined self-reported rates of receiving psychotherapy and medication for psychological distress in patients one month after a suspected ACS event, and compared rates across demographic and mental health categories.

Section snippets

Sample

English- and Spanish-speaking participants were enrolled during evaluation for suspected ACS in the emergency department (ED) at New York-Presbyterian Hospital as part of the REactions to Acute Care and Hospitalization (REACH) study, an ongoing observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected ACS [12]. Potential participants were identified by a provisional diagnosis of “probable ACS” by the treating ED physician. Exclusion

Results

Approximately 15% of the entire sample (n = 68) reported receiving some form of treatment. A total of 28 (6.3%) individuals reported receiving counseling, 16 (3.6%) individuals reported receiving medication, and 24 (5.4%) individuals reported receiving both. There were no significant differences in treatment rate as a function of demographics, ACS status, or insurance coverage (ps > 0.1), see Table 1.

Thirty-three percent of the sample (N = 146) screened positive for depression, PTSD, or both. Of

Discussion

PTSD and depression are common after acute cardiac events (e.g., [2], [4]). Generally little research has been published addressing mental health treatment rates for cardiac patients, but the few existing studies suggest that these patients are frequently undertreated (e.g., [7]). This report is among the first to consider treatment rates for emotional distress after evaluation for suspected ACS. Our sample comprised patients evaluated for suspected ACS with relatively low SES and diverse

Conclusions

PTSD and depression after cardiac events have been associated with poor prognosis. This study suggests that 25% of low SES, racially/ethnically diverse patients in an urban setting who screen positive for one or both disorders may receive treatment. Currently, evidence demonstrating that treatment improves cardiovascular prognosis is limited, but this is a heartening finding nonetheless and should be replicated with medical records in more diverse samples.

Competing interest statement

The authors have no competing interests to report.

Acknowledgements

Dr. Edmondson was supported by the National Heart, Lung, and Blood Institute (NHLBI): R01s HL117832 and HL128497. Dr. Sumner was supported by NHLBI K01 HL130650.

References (14)

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