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Stroke survivors with PTSD struggle with treatment

Friday February 15, 2013
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Stroke survivors with post-traumatic stress disorder are less likely to adhere to treatment regimens that reduce the risk of an additional stroke, according to a study.

Researchers found that 65% of stroke survivors with PTSD failed to adhere to treatment, compared with 33% of those without PTSD. The survey also suggests that nonadherence in PTSD patients is partly explained by increased ambivalence toward medication. Among stroke survivors with PTSD, 38% had concerns about their medications.

According to data from the American Stroke Association, nearly 795,000 Americans each year suffer a new or recurrent stroke. Stroke is the fourth-leading cause of death and the top cause of disability in the United States. Survivors of strokes often are prescribed treatment regimens, including antiplatelet agents, antihypertensive agents and statins, which help reduce the risk of subsequent strokes. Previous research has shown that PTSD triggered by medical events — which affects 18% of stroke survivors — may affect recovery.

"Unfortunately, too many stroke survivors are not compliant with these regimens, even though we know that adherence to post-stroke regimens is one of the most important components of reducing the risk of a future stroke," Ian M. Kronish, MD, MPH, a study author and an assistant professor of medicine at the Center for Behavioral and Cardiovascular Health, Columbia University Medical Center, New York City, said in a news release.

"For those with PTSD, this study shows that concerns about medications are a significant barrier to treatment adherence. Stroke survivors should be assessed for concerns about medications and PTSD symptoms, so that interventions may be introduced as early as possible to get patients back on track to avoid future stroke events."

The researchers asked 535 stroke survivors about PTSD symptoms, adherence to medications and beliefs or concerns about medications. Participants were recruited between March 2010 and January 2012 as part of Mount Sinai Medical Schoolís Preventing Recurrence of All Inner City Strokes through Education clinical trial in Harlem and the Bronx. Participants were eligible for the trial if they were at least 40 and had self-reported a history of stroke or transient ischemic attack in the previous five years years (average was 1.9 years after most recent stroke or TIA).

Compared with stroke patients without PTSD symptoms, patients with PTSD felt more ambivalence toward medication, worried more about the long-term effects of medication and complained about the way medication disrupted their lives. Furthermore, PTSD was associated with somewhat increased belief in the general harm and overuse of medications in the healthcare system.

Previous research with the same cohort had found that stroke survivors with the most severe PTSD symptoms were nearly three times as likely as those without PTSD symptoms to be nonadherent to medications.

"We believe that these findings suggest that stroke survivors with PTSD do not see their medications as helpful, but rather as reminders of their stroke, and that they avoid taking them as a way to avoid thinking about their stroke," said Donald Edmonson, PhD, the studyís first author and an assistant professor of behavioral medicine at Columbia University Medical Center. "We need to conduct further research to determine whether treating a stroke survivor for PTSD would alleviate medication concerns that lead to avoidance, or if additional interventions should be designed to address both issues."

The study is scheduled for publication in the British Journal of Health Psychology. The study abstract is available at http://onlinelibrary.wiley.com/doi/10.1111/bjhp.12022/abstract.


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