Effect of Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome at Long-Term Follow-Up

Mary Princip; Aju P Pazhenkottil; Jürgen Barth; Ulrich Schnyder; Hansjörg Znoj; Jean-Paul Schmid; Rebecca E Langraf-Meister; Roland von Känel; Katharina Ledermann

doi:10.3389/fpsyt.2022.846397

Effect of Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome at Long-Term Follow-Up

Front Psychiatry. 2022 May 30:13:846397. doi: 10.3389/fpsyt.2022.846397. eCollection 2022.

Authors

Mary Princip¹, Aju P Pazhenkottil^{1

2

3}, Jürgen Barth⁴, Ulrich Schnyder¹, Hansjörg Znoj⁵, Jean-Paul Schmid⁶, Rebecca E Langraf-Meister^{1

7}, Roland von Känel¹, Katharina Ledermann^{1

8}

Affiliations

¹ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
³ Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁵ Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology, Clinic Gais, Gais, Switzerland.
⁷ Clienia Schlössli AG, Oetwil am See, Switzerland.
⁸ Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland.

Abstract

Objective: Psychological consequences of myocardial infarction (MI) are substantial, as 4% of all MI patients develop posttraumatic stress disorder (PTSD) and 12% clinically relevant posttraumatic stress symptoms (PTSS). The study investigated the course and development within 12 months of MI-induced PTSS to gain novel insights in potentially delayed response to early trauma-focused counseling aimed at preventing the incidence of MI-induced PTSS.

Methods: In the MI-SPRINT two-group randomized controlled trial, 190 MI-patients were randomly allocated to receive a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 12-month follow-up.

Results: 12-month follow-up of outcomes were available for 106 (55.8%) of 190 participants: In the entire sample, one patient (0·5%, 1/190) who received trauma-focused counseling developed full PTSD. There was no significant difference between trauma-focused counseling and stress counseling regarding total score of interviewer-rated PTSS (p > 0.05). The only group difference emerged in terms of more severe hyperarousal symptoms in the trauma-focused counseling group in the ITT analysis, but not in the completer analysis.

Conclusions: No benefits were found for trauma-focused counseling after 12 months when compared with an active control intervention. PTSD prevalence in the present study was low highlighting a potential beneficial effect of both interventions. Further studies are needed to determine the most accurate approach of counseling.

Keywords: acute coronary care; acute trauma stress; behavioral cardiology; counseling; early prevention; myocardial infarction; posttraumatic stress symptoms.