Prior stroke predicts posttraumatic stress disorder (PTSD) in a multi-ethnic cohort of stroke survivors: Evidence from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial

Poststroke PTSD is associated with reduced quality of life and poor medication adherence in stroke survivors. Although prior traumatic events have been linked to elevated PTSD risk from a subsequent event, no study has examined whether prior stroke experience increases PTSD risk following a subsequent stroke.

Data come from DESERVE, a randomized controlled trial of mild stroke/transient ischemic attack (TIA) patients prospectively enrolled in a behavioral intervention to reduce vascular risk. Symptoms of partial or full PTSD related to the index stroke/TIA were assessed for 241 patients at six month follow-up using the PTSD Checklist. PTSD was defined as meeting DSM-IV criterion B and either criterion C or D. Chi-square tests and logistic regression were used to examine the association between prior stroke/TIA experience and PTSD related to the index stroke. Regression models were adjusted for age, race/ethnicity and disability at discharge.

Almost one-third (32.7%) of patients experienced a prior stroke/TIA. The prevalence of PTSD six months after discharge was 9.4% and was significantly higher among those with a prior stroke/TIA compared with those without (17.3% vs. 5.6%, p=0.02). Patients with prior stroke/TIA had 5.5 times greater odds of developing PTSD from the index stroke compared with those without (95% CI: 1.2-25.1).

Given the substantial proportion of stroke survivors who experience a recurrent stroke and the negative mental health consequences highlighted in this study, interventions that focus on prevention are critical for promoting mental and physical well-being in stroke survivors.