Post-traumatic stress symptoms and exacerbations in COPD patients

Abstract

Background: Post-Traumatic Stress Disorder (PTSD) is a common psychological consequence of exposure to traumatic stressful life events. During COPD exacerbations dyspnea can be considered a near-death experience that may induce post-traumatic stress symptoms. The aim of this study was to evaluate the relationship between COPD exacerbations and PTSD- related symptoms. Method: Thirty-three in-patients with COPD exacerbations were screened for the following: PTSS (Screen for Posttraumatic Stress Symptoms), anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory). Patients had a median age of 72 years and 72.7 were female. Results: Mean FEV1 and FVC were 0.8±0.3 (37.7 ± 14.9 of predicted) and 1.7 ± 0.6 (60 ± 18.8 of predicted), respectively with a mean exacerbation of 2.9 episodes over the past year. Post-traumatic stress symptoms related to PTSD were found in 11 (33.3) patients (SPTSS mean score 4.13 ± 2.54); moderate to severe depression in 16 (48.5) (BDI mean score 21.2 ± 12.1) and moderate to severe anxiety in 23 (69.7) (BAI mean score 23.5 ± 12.4). In a linear regression model, exacerbations significantly predicted post-traumatic stress symptoms scores: SPTSS scores increased 0.9 points with each exacerbation (p 0.001). Significant correlations were detected between PTSD-related symptoms and anxiety (rs 0.57; p 0.001) and PTSD symptoms and depression (rs 0.62; p 0.0001). In a multivariable analysis model, two or more exacerbation episodes led to a near twofold increase in the prevalence ratio of post-traumatic stress symptoms related to PTSD(PR1.71; p 0.015) specially those requiring hospitalization (PR 1.13; p 0.030) Conclusion: PTSD symptoms increase as the patient's exacerbations increase. Two or more exacerbation episodes lead to a near twofold increase in the prevalence ratio of post-traumatic symptomatology. Overall, these findings suggest that psychological domains should be addressed along with respiratory function and exacerbations in COPD patients.