Review articleAnxiety, depression, and PTSD following cardiac arrest: A systematic review of the literature☆
Introduction
Out-of-hospital sudden cardiac arrest (OHCA) affects more than 300,000 individuals in the United States each year.1, 2 Recent research and medical care innovations have successfully increased survival rates after cardiac arrest more than five-fold in some specialized treatment settings.3 With increased number of survivors, comprehensive outcomes research is needed to characterize the potential residual impairments and disabilities they face. However, the vast majority of outcomes research in this population has focused on medical outcomes, with little attention given to the psychological aftermath of surviving a cardiac arrest.4
A review of the literature on psychological well-being after cardiac arrest reveals several short-comings. First, there are relatively few studies that focus primarily on psychological concerns; most address patients’ psychological condition superficially, with their primary focus on other outcomes (e.g., neurological status, cognitive functioning, functional status and cardiac function).5, 6, 7 Among the few studies that focus on psychological distress, investigators have reported widely varying estimates of occurrence rates.8, 9, 10, 11
Second, several studies struggle to adequately distinguish between concepts like quality of life and psychological conditions.10, 12 Although the two constructs may be correlated, they are, in fact, distinct entities. Quality of life is a broad construct which encompasses many aspects of the patient's life, whereas, psychological conditions relate to distinct pathology as defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV TR13). Quality of life can be affected by, but is quite distinct from psychological conditions such as depression, anxiety, and posttraumatic stress disorder (PTSD).
Given that mental health disorders have not been well characterized in the cardiac arrest literature, there is a concern that psychological disorders following cardiac arrest have not received proper attention from researchers or clinicians. The high incidence and impact of concomitant psychological disease in patients who have undergone other life-changing medical events (e.g., MI and Stroke)14, 15, 16 suggests that investigations of psychological distress following cardiac arrest should not be neglected. Identifying psychopathology after cardiac arrest will help practitioners appreciate the full spectrum of arrest outcomes and develop holistic interventions.
The aims of the current study are to review the existing literature on psychological outcomes after cardiac arrest and (1) identify the occurrence rate of psychological distress among patients with cardiac arrest, (2) evaluate methodological approaches to research on psychological distress, (3) suggest priorities for future research, and (4) address implications for clinical practice.
Section snippets
Search strategy
To identify studies that addressed psychiatric disorders and psychological distress associated with cardiac arrest, a systematic review of the literature was conducted. All studies published within the last 20 years were considered. The electronic databases PubMed/MEDLINE and PsychInfo/APA PsycNET were utilized. PubMed in the United States National Library of Medicine for the National Institutes of Health and includes more than 21 million citations for biomedical literature. APA PsycNET® is a
Results
More than 2200 articles were identified via literature search. The Pub Med/Medline search included 2151 articles and the PsychINFO search included 91 articles. More than 40 additional articles were identified using reference list search. Thirty two articles met screening criteria for detailed review of which 11 met the stated inclusion and exclusion criterion (see Table 1).
Psychological distress after cardiac arrest
A number of investigators have considered psychological distress after cardiac arrest, but few have reported incidence rates of the most common forms of psychopathology, anxiety, depression, and posttraumatic stress disorder. Of those that have reported, some generalizations can be drawn about post-cardiac arrest emotional disturbance. Outpatient studies are greater in number and suggest that the occurrence rate of anxiety, depression and, PTSD is highly variable. The rate of clinically
Conflict of interest statement
None of the authors have any conflicts of interest, financial or otherwise, relevant to the content of this manuscript.
Acknowledgments
Appreciation is expressed to the ARCTIC investigators: Harinder Dhindsa, MD, Michael Kurz, MD, Renee Reid, MD, and Charlotte Roberts, RN, NP.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.11.021.