Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks.


BACKGROUND AND PURPOSE: Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications. METHODS: We surveyed 535 participants, age ≥40 years old, who had at least 1 stroke or TIA in the previous 5 years. PTSD was assessed using the PTSD Checklist-Specific for stroke; a score ≥50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression. RESULTS: Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke ≥50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%, P<0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7-4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke <25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence. CONCLUSION: PTSD is common after stroke/TIA. Patients who have PTSD after stroke or TIA are at increased risk for medication nonadherence.


Kronish, Ian M; Edmondson, Donald; Goldfinger, Judith Z; Fei, Kezhen; Horowitz, Carol R;


  • Adult
  • Aged
  • Depression/ etiology
  • Depression/ psychology
  • Female
  • Humans
  • Ischemic Attack, Transient/ complications
  • Ischemic Attack, Transient/ psychology
  • Logistic Models
  • Male
  • Medication Adherence/ statistics & numerical data
  • Middle Aged
  • Predictive Value of Tests
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic/ etiology
  • Stress Disorders, Post-Traumatic/ psychology
  • Stroke/ complications
  • Stroke/ psychology
  • Surveys and Questionnaires
  • Survivors/ psychology
  • Treatment Outcome

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