Abstract 3257: Prevalence and Correlates of PTSD After Stroke
Background Stroke survivors may be at increased risk for post-traumatic stress disorder (PTSD), yet detailed data on prevalence and contributing factors are lacking. Harlem residents and local researchers, alarmed by high rates of stroke in their community and frustrated by the difficulty of engaging stroke survivors in prevention programs, aimed to determine the prevalence and correlates of PTSD in a cohort of survivors of stroke and transient ischemic attack (TIA).
Methods Harlem residents and researchers employed community-based participatory research to develop a recurrent stroke prevention intervention. English and Spanish speaking adults over 40 were eligible for inclusion if they reported a stroke or TIA within the past five years. Baseline assessments included blood pressure, direct LDL cholesterol and validated self-report scales for demographics, stroke impact (modified Rankin scale), medical co-morbidities (Charlson co-morbidity index), and the widely-used 17-item PTSD Checklist Specific for stroke (PCL-S). A PCL-S score of 25 connotes a positive screening test, while a score greater than 50 is highly specific for PTSD. We recruited participants from community and clinical sites. To create a model of correlates for PTSD (PCL-S score > 50), we used logistic regression.
Results The 379 enrollees had a mean age of 64 years, 62% were women, 79% were Black or Latino, 28% never completed high school, and more than half earned under $15,000 yearly. Most (75%) had PCL-S scores greater than 25, including 69 (18%) who scored above 50. Using logistic regression, and controlling for gender, race, education, and income (c-statistic of 0.835, p<0.0001), PTSD was associated with younger age (odds ratio 0.94, 95% CI 0.91-0.97), increased disability post-stroke (OR 1.93, 95% CI 1.49-2.51), and greater burden of medical co-morbidities (OR 2.17, 95% CI 1.09-4.31). In addition, participants with PTSD were more likely to smoke (30% vs. 13%, p=0.0003) and have elevated LDL cholesterol > 100 mg/ dl (59% vs. 39%, p=0.003), both major risk factors for recurrent stroke. There was no significant difference in blood pressure control between the patients with and without PTSD.
Conclusion PTSD is common after stroke, especially in younger people with more disability and more co-morbidity. We recommend that clinicians screen patients for PTSD after stroke and offer supportive therapy.
- © 2012 by American Heart Association, Inc.