Posttraumatic stress disorder (PTSD) and depression are common after stroke and associated with poor outcomes in stroke survivors. Although prior traumatic event experience has been linked to elevated risk of PTSD from a subsequent event, few studies have examined the influence of prior stroke experience on mental health conditions following a subsequent stroke. We hypothesized that prior stroke/TIA experience would be associated with PTSD and depression independently of PTSD following stroke. As part of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, a multi-ethnic group of mild/moderate stroke/TIA patients were enrolled in a behavioral intervention to reduce vascular risk. Symptoms of partial or full PTSD and depression were assessed in a six month follow-up survey in 134 patients using the PTSD Checklist and Center for Epidemiologic Studies - Depression scale (CES-D), respectively. PTSD was defined as meeting any DSM-IV criterion B-D, and depression as those with CES-D scores ≥ 8. Patients were categorized as having: 1) no depression or PTSD, 2) depression only, or 3) PTSD (with or without depression). Chi-square tests and multinomial logistic regression were used to examine the association between prior stroke/TIA experience and depression/PTSD. One-third (33.1%) of patients had experienced a prior stroke or TIA. At follow-up, 9.0% and 34.3% of patients met criteria for PTSD and depression without PTSD, respectively. Patients with prior stroke/TIA had 3.6 times greater odds of developing PTSD from the index stroke (95% CI: 1.0-13.3) and 2.7 times the odds of depression only (95% CI: 1.2-6.3) after controlling for age and race/ethnicity. Stroke/TIA patients who had experienced a previous stroke/TIA had significantly greater odds of developing not only PTSD but also depression than those who had not had a previous stroke/TIA. Given the high rate of recurrent stroke and the negative mental health consequences highlighted in this study, interventions that focus on prevention of recurrent stroke are crucial for promoting both physical and psychological well-being among stroke survivors.
Posttraumatic stress disorder in African Americans: A two year follow-up study
