Abstract 18827: Emergency Department Threat Perceptions and PTSD Symptoms After Suspected Stroke

Introduction: Stroke is a leading cause of death, physical, and psychological disability in the United States. One in four stroke survivors develop significant PTSD symptoms (PTSS), which can influence disease outcomes. It is important to identify factors that increase early psychological distress and subsequent PTSS development, such as threat perceptions in the emergency department (ED). Understanding the relationship between ED threat and PTSS may help identify areas for improving early stroke care. The purpose of this study was to determine whether ED threat perceptions influence PTSS development at 1-, 6- and 12-months after suspected stroke.

Methods: The sample consisted of patients (n = 203, 48% female, 59.4 ± 15.5 years) who presented to the ED of an academic medical center for suspected stroke. ED threat was assessed in-hospital using the ED Threat Perceptions questionnaire, and PTSS were assessed at 1-, 6- and 12- months post-stroke using the PCL-5 tool. Linear regression was used to assess the association between ED threat and PTSD symptoms, adjusting for demographics, depression, chronic disease severity (Charlson index), and stroke severity (NIHSS).

Results: In unadjusted analyses, ED threat perceptions were associated with higher PTSS at 1- (β=0.42, 95% CI [0.16-0.68] p=0.002), 6- (β=0.32, 95% CI [0.07-0.58], p=0.013), and 12-mo (β=0.44, 95% CI [0.15-0.72], p=0.003), independent of demographics, stroke severity, and depressive symptoms when expressed continuously. In nested models, addition of ED threat perceptions to a model including demographics and stroke severity significantly improved the model (Δ-2 log likelihood = 7.15, df=1; p=0.007), indicating independent effects in the association of ED threat perceptions with PTSD symptoms beyond stroke severity.

Conclusions: ED threat perceptions were associated with higher PTSS at 1-, 6-, and 12-months after suspected stroke even after accounting for clinician-measured stroke severity. This suggests that early threat perceptions contribute to PTSD risk above and beyond the physical impact of the event. These results indicate the importance of the ED environment and provide a target for future interventions to minimize the development of PTSD symptoms post-stroke.