Health Psychology Research / HPR / Volume 13 / Issue 1 / DOI: 10.52965/001c.129914
Cite this article
1
Download
9
Citations
18
Views
Journal Browser
Volume | Year
Issue
Search
News and Announcements
View All
ORIGINAL RESEARCH

Psychological Factors and Post-Traumatic Stress Disorder (PTSD) Risk in Stroke Survivors: A Cross-Sectional Study

Ngoc Huy Nguyen1,2 Son Dinh Thanh Le1 Ha Thi Thu Bui1 Viet Quoc Hoang1 Cuong Cao Do1
Show Less
1 Phutho Department of Health, Phutho province, Vietnam
2 VNU University of Medicine and Pharmacy, Hanoi, Vietnam
Submitted: 13 November 2024 | Accepted: 16 January 2025 |
© 2025 by the Author(s). Licensee Health Psychology Research, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract

Introduction

As of 2023, stroke is the second leading cause of death and the third leading cause of death and disability globally, with an expected rise by 2030. While traditional risk factors like demographics, smoking, inactivity, diabetes, and hypertension are well-known, post-traumatic stress disorder (PTSD) remains under-studied despite its 13% incidence rate and link to stroke risk.

 

Methods

This cross-sectional study, conducted from 1st November, 2023 to 30th January, 2024 in Doanhung, Phutho Province, involved stroke patients over 18 years old diagnosed within the past year. A 56-question questionnaire assessed demographics, clinical characteristics, the Barthel Index, and the PTSD Checklist for DSM-5 (PCL-5). Multivariable logistic regression using Stepwise AIC identified optimal models related to PTSD.

 

Results

A cohort of 397 participants, with a mean age of 67.98 years and 54.9% female, had a PTSD prevalence of 10.8%. Significant PTSD predictors included regular alcohol consumption (OR=11.43, 95% CI: 1.30–99.15, p=0.027), slight memory decrease (OR=3.59, 95% CI: 1.28–10.62, p=0.017), female gender (OR=3.15, 95% CI: 1.08–10.44, p=0.045), extroverted personality (OR=4.36, 95% CI: 1.73–11.86, p=0.003), and Barthel Index scores (OR=0.85, 95% CI: 0.80–0.90, p<0.001). However, age showed marginally significant association with PTSD (OR=0.97, 95% CI: 0.94–1.00, p=0.067), and unconsciousness during stroke (yes) had an OR of 2.43 (95% CI: 0.96–6.04, p=0.056).

 

Conclusion

This study highlights the complex interplay of demographic, lifestyle, and clinical factors influencing PTSD risk in stroke survivors. Addressing these factors in interventions is crucial to reduce the psychological burden and improve rehabilitation outcomes.

References
1.Pu L et al. Projected Global Trends in Ischemic Stroke Incidence, Deaths and Disability-Adjusted Life Years From 2020 to 2030. Stroke. 2023;54:1330-1339. doi:10.1161/​STROKEAHA.122.040073
Google Scholar
2.Feigin VL et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke. 2022;17:18-29. doi:10.1177/​17474930211065917
Google Scholar
3.Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circulation Research. 2017;120:472-495. doi:10.1161/​CIRCRESAHA.116.308398
Google ScholarPubMed CentralPubMed
4.Howard VJ et al. Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors. JAMA Neurol. 2019;76:179. doi:10.1001/​jamaneurol.2018.3862
Google ScholarPubMed CentralPubMed
5.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Physical Health Conditions Associated with Posttraumatic Stress Disorder in U.S. Older Adults: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J American Geriatrics Society. 2012;60:296-303. doi:10.1111/​j.1532-5415.2011.03788.x
Google ScholarPubMed CentralPubMed
6.Scherrer JF et al. Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease. JAHA. 2019;8:e011133. doi:10.1161/​JAHA.118.011133
Google ScholarPubMed CentralPubMed
7.Gibson CJ, Li Y, Inslicht SS, Seal KH, Byers AL. Gender Differences in Cardiovascular Risk Related to Diabetes and Posttraumatic Stress Disorder. The American Journal of Geriatric Psychiatry. 2018;26:1268-1272. doi:10.1016/​j.jagp.2018.09.012
Google Scholar
8.Song H et al. Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ. 2019;365:l1255.
Google Scholar
9.Edmondson D et al. Prevalence of PTSD in Survivors of Stroke and Transient Ischemic Attack: A Meta-Analytic Review. PLoS ONE. 2013;8:e66435. doi:10.1371/​journal.pone.0066435
Google ScholarPubMed CentralPubMed
10.Perkins JD, Wilkins SS, Kamran S, Shuaib A. Post-traumatic stress disorder and its association with stroke and stroke risk factors: A literature review. Neurobiology of Stress. 2021;14:100332. doi:10.1016/​j.ynstr.2021.100332
Google ScholarPubMed CentralPubMed
11.Garton ALA, Sisti JA, Gupta VP, Christophe BR, Connolly ES. Poststroke Post-Traumatic Stress Disorder: A Review. Stroke. 2017;48:507-512. doi:10.1161/​STROKEAHA.116.015234
Google ScholarPubMed CentralPubMed
12.Nanavati HD, Arevalo A, Memon AA, Lin C. Associations between posttraumatic stress and stroke: A systematic review and meta-analysis. J Trauma Stress. 2023;36:259-271. doi:10.1002/​jts.22925
Google ScholarPubMed CentralPubMed
13.Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS ONE. 2020;15:e0241032. doi:10.1371/​journal.pone.0241032
Google ScholarPubMed CentralPubMed
14.Hiscox LV, Sharp TH, Olff M, Seedat S, Halligan SL. Sex-Based Contributors to and Consequences of Post-traumatic Stress Disorder. Curr Psychiatry Rep. 2023;25:233-245. doi:10.1007/​s11920-023-01421-z
Google ScholarPubMed CentralPubMed
15.Malivoire BL, Girard TA, Patel R, Monson CM. Functional connectivity of hippocampal subregions in PTSD: relations with symptoms. BMC Psychiatry. 2018;18:129. doi:10.1186/​s12888-018-1716-9
Google ScholarPubMed CentralPubMed
16.Jing X, Lu L, Yao Y. Personality modifies the effect of post-traumatic stress disorder (PTSD) and society support on depression-anxiety-stress in the residents undergone catastrophic flooding in Henan, China. Med Pr. Published online 2022. doi:10.13075/​mp.5893.01254
Google Scholar
17.Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: A reliability study. International Disability Studies. 1988;10:61-63. doi:10.3109/​09638288809164103
Google Scholar
18.Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience. 2011;13:263-278. doi:10.31887/​DCNS.2011.13.2/​jsherin
Google ScholarPubMed CentralPubMed
19.Wortmann JH et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment. 2016;28:1392-1403. doi:10.1037/​pas0000260
Google Scholar
20.Zhang Z. Variable selection with stepwise and best subset approaches. Ann Transl Med. 2016;4:136-136.
Google Scholar
21.R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2022.
Google Scholar
22.Edmondson D et al. Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-analytic Review. PLoS ONE. 2012;7:e38915. doi:10.1371/​journal.pone.0038915
Google ScholarPubMed CentralPubMed
23.Alhalabi MN et al. Palliative care needs of Jordanian women’s experience of living with stroke: a descriptive phenomenological study. BMC Palliat Care. 2023;22:106. doi:10.1186/​s12904-023-01216-2
Google ScholarPubMed CentralPubMed
24.Hwang WJ, Lee TY, Kim NS, Kwon JS. The Role of Estrogen Receptors and Their Signaling across Psychiatric Disorders. IJMS. 2020;22:373. doi:10.3390/​ijms22010373
Google ScholarPubMed CentralPubMed
25.Jauhar S, Marshall EJ, Smith ID. Alcohol and cognitive impairment. Adv psychiatr treat. 2014;20:304-313.
Google Scholar
26.Carnes-Vendrell A, Deus J, Molina-Seguin J, Pifarré J, Purroy F. Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep. 2019;9:16248.
Google Scholar
27.Aam S et al. Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study. Front Neurol. 2020;11:699.
Google Scholar
28.Chi X et al. Research trends and hotspots of post-stroke cognitive impairment: a bibliometric analysis. Front Pharmacol. 2023;14:1184830.
Google Scholar
29.Kirkevold M et al. Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial. BMC Psychol. 2018;6:12.
Google Scholar
30.Lugtmeijer S, Lammers NA, De Haan EHF, De Leeuw FE, Kessels RPC. Post-Stroke Working Memory Dysfunction: A Meta-Analysis and Systematic Review. Neuropsychol Rev. 2021;31:202-219. doi:10.1007/​s11065-020-09462-4
Google ScholarPubMed CentralPubMed
31.He M et al. Relationships Between Memory Impairments and Hippocampal Structure in Patients With Subcortical Ischemic Vascular Disease. Front Aging Neurosci. 2022;14:823535.
Google Scholar
32.Pitts BL, Eisenberg ML, Bailey HR, Zacks JM. PTSD is associated with impaired event processing and memory for everyday events. Cogn Research. 2022;7:35. doi:10.1186/​s41235-022-00386-6
Google ScholarPubMed CentralPubMed
33.Calhoun CD et al. The Role of Social Support in Coping with Psychological Trauma: An Integrated Biopsychosocial Model for Posttraumatic Stress Recovery. Psychiatr Q. 2022;93:949-970. doi:10.1007/​s11126-022-10003-w
Google ScholarPubMed CentralPubMed
34.Silveira K, Garcia-Barrera MA, Smart CM. Neuropsychological Impact of Trauma-Related Mental Illnesses: A Systematic Review of Clinically Meaningful Results. Neuropsychol Rev. 2020;30:310-344. doi:10.1007/​s11065-020-09444-6
Google Scholar
35.Yuan S, He Y. Effects of physical therapy on mental function in patients with stroke. J Int Med Res. 2020;48:300060519861164. doi:10.1177/​0300060519861164
Google ScholarPubMed CentralPubMed
36.Barman A, Chatterjee A, Bhide R. Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury. Indian Journal of Psychological Medicine. 2016;38:172-181. doi:10.4103/​0253-7176.183086
Google ScholarPubMed CentralPubMed
37.Saunders DH et al. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database of Systematic Reviews. 2021;2021. doi:10.1002/​14651858.CD012996.pub2
Google ScholarPubMed CentralPubMed
38.Elloker T, Rhoda AJ. The relationship between social support and participation in stroke: A systematic review. Afr j disabil. 2018;7. doi:10.4102/​ajod.v7i0.357
Google ScholarPubMed CentralPubMed
39.Billinger SA et al. Physical Activity and Exercise Recommendations for Stroke Survivors: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014;45:2532-2553. doi:10.1161/​STR.0000000000000022
Google Scholar
40.Zhang C et al. Psychometric properties of the Barthel Index for evaluating physical function among Chinese oldest-old. JCSM Clinical Reports. 2022;7:33-43. doi:10.1002/​crt2.47
Google Scholar
41.Mazzeo S et al. Depressive Symptoms Moderate the Association Between Functional Level at Admission to Intensive Post-Stroke Rehabilitation and Effectiveness of the Intervention. J Geriatr Psychiatry Neurol. 2024;37:222-233. doi:10.1177/​08919887231204543
Google Scholar
42.West R, Hill K, Hewison J, Knapp P, House A. Psychological Disorders After Stroke Are an Important Influence on Functional Outcomes: A Prospective Cohort Study. Stroke. 2010;41:1723-1727. doi:10.1161/​STROKEAHA.110.583351
Google Scholar
43.Notsuyu A et al. Relationship between grip strength during hospitalisation and mental disorders after discharge in critically ill patients: a post-hoc analysis of a prospective observational study. BMJ Open. 2023;13:e068983. doi:10.1136/​bmjopen-2022-068983
Google ScholarPubMed CentralPubMed
44.Jiang C et al. Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage. Front Neurosci. 2022;16:1007571. doi:10.3389/​fnins.2022.1007571
Google ScholarPubMed CentralPubMed
Share
Back to top
Health Psychology Research, Electronic ISSN: 2420-8124 Published by Health Psychology Research