PTSD Symptoms in Cardiac Patients: Gender, Psychosocial Wellbeing, and Strength Factors

Background: Women are more likely to develop symptoms of post-traumatic stress disorder (PTSD) following a life-threatening event, while women with heart disease (HD) are more vulnerable than their male conterparts. Increasingly, research has associated PTSD-like symptoms with physical health conditions, including HD. Open-heart surgery (OHS) is a life-altering event for HD patients, which can lead to distress and existential struggles. A few studies have associated PTSD with poor post-OHS outcomes. However, these symptoms could have developed even before this major medical event, namely when the decision is made by cardiac surgeon for patients with advanced HD. In this interdisciplinary cross-sectional study, we investigated relations between pre-OHS factors and PTSD-like symptoms, which we termed as acute stress, controlling for objectively assessed medical and cardiac indices. We expected that (1) female HD patients would be more likely to have PTSD-like symptoms; (2) pre-OHS medical comorbidities and impacted quality-of-life (QOL) indicators might explain the gender effect; and (3) certain character strengths (optimism/hope and spirituality) could mitigate these symptoms, even after controlling for medical confounders. Methods: We recruited 481 patients (male, 58%; mean age=62 years, range=35-89) two weeks before surgery for psychosocial interviews using standardized instruments. Acute stress or PTSD-like symptoms were assessed two days prior to surgery. Objectively assessed medical and cardiac indices were obtained from the Society of Thoracic Surgeon’s (STS) national database used by all cardiac surgeons. Multivariate analyses were performed to test our hypotheses following pre-planned steps. Results: While women had significantly higher symptom levels of acute stress, multiple regression analyses showed a direct gender effect on acute stress in Step-1 regression. Older age was associated with reduced acute stress, even after the entry of general health, cardiac health risks, and QOL factors in Step-2. However, the gender effect vanished, while impacted psychosocial wellbeing, as an indicator of poor QOL, and medical comorbidities were related to acute stress. The role of the three significant factors remained after the entry of cardiac indices in Step-3, while hypertension and Class-NYHA were linked with acute stress. When psychosocial strength factors were added to Step-4, dispositional optimism and subjective religiousness were inversely, but post-OHS usage of assessed prayer coping was positively, associated with acute stress. Yet, the role of two cardiac indices were eliminated, and that of medical comorbidities became marginal. A post-hoc analysis supported the mediation of impacted psychosocial wellbeing on the sex differences in acute stress. Conclusion: The present study suggests women’s higher levels of acute stress that, however, might be related to the greater illness/event impact on their psychosocial wellbeing. Dispositional optimism, as a personality strength, and subjective religiousness could mitigate acute stress prior to a life-altering operation, while distressed patients tended to pursue private prayer to coping with the related existential stress. The finding is reliable given its large sample and adequate adjustment for objective medical indices. If the study could be replicated, behavioral health care providers should pay more attention to amendable poor QOL of women prior to the medical event.