Posttraumatic stress disorder in the family and friends of patients who have suffered spontaneous subarachnoid hemorrhage

Clinical article

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Object

Significant others (SOs), such as spouses and life partners, of patients who have survived subarachnoid hemorrhage (SAH) can experience psychiatric symptoms and psychosocial disability. The cause of such symptoms has not been established. Authors of the present study analyzed whether posttraumatic stress disorder (PTSD) subsequent to a loved one's SAH is a plausible explanation for these symptoms.

Methods

The authors examined a large representative sample of 86 patient/SO pairs 3.5 months postictus. All SOs were evaluated using a diagnostic PTSD measure, and coping skills were assessed. The cognitive, physical, and emotional status of patients was comprehensively examined.

Results

Twenty-six percent of SOs met the diagnostic criteria for PTSD, which represents a 3-fold increase in the rate expected within the general population. To establish the cause of PTSD, a logistic regression was performed, and results of this test showed that the use of maladaptive coping strategies was the best predictor of the disorder. A patient's level of disability held no significant association with the development of PTSD in his or her SO.

Conclusions

The elevated incidence of PTSD in SOs helps to explain why these persons report concerning levels of psychiatric symptomatology and psychosocial disability. Greater attention must be given to an SO's adjustment to the experience of having a loved one suffer an SAH. This need is all the more pertinent given that SOs often act as informal caregivers and that PTSD could interfere with their ability to effectively minister. Because bad coping skills seem to be the main cause of PTSD, teaching SOs better strategies might prevent the disorder and any resulting psychosocial disability.

Abbreviations used in this paper: BADS = Behavioral Assessment of the Dysexecutive Syndrome; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, ed 4; FIM-MS = Functional Independence Measure–Motor Subscale; HADS = Hospital Anxiety and Depression Scale; IQR = interquartile range; OR = odds ratio; PDS = Posttraumatic Stress Diagnostic Scale; PTSD = posttraumatic stress disorder; RBMT-E = Rivermead Behavioural Memory Test; SAH = subarachnoid hemorrhage; SD = standard deviation; SO = significant other; TEA = Test of Everyday Attention; WFNS = World Federation of Neurosurgical Societies.

Article Information

Address correspondence to: Adam J. Noble, B.Sc., Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, United Kingdom. email: a_j_noble@hotmail.com.

© AANS, except where prohibited by US copyright law.

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    Graph showing the relationship between the probability of PTSD and the use of maladaptive coping strategies (OR = 4.292). Values on the x axis represent the degree to which a person typically used maladaptive coping strategies. Higher values indicate more frequent use of such strategies.

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