Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

Lotte Kok, Milou S Sep, Dieuwke S Veldhuijzen, Sandra Cornelisse, Arno P Nierich, Joost van der Maaten, Peter M Rosseel, Jan Hofland, Jan M Dieleman, Christiaan H Vinkers, Marian Joëls, Diederik van Dijk, Manon H Hillegers, DECS study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.

METHODS: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.

RESULTS: PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.

LIMITATIONS: The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.

CONCLUSIONS: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

Original languageEnglish
Pages (from-to)216-223
Number of pages8
JournalJournal of Affective Disorders
Volume206
DOIs
Publication statusPublished - Dec 2016
Externally publishedYes

Cite this

Kok, L., Sep, M. S., Veldhuijzen, D. S., Cornelisse, S., Nierich, A. P., van der Maaten, J., ... DECS study group (2016). Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients. Journal of Affective Disorders, 206, 216-223. https://doi.org/10.1016/j.jad.2016.07.020
Kok, Lotte ; Sep, Milou S ; Veldhuijzen, Dieuwke S ; Cornelisse, Sandra ; Nierich, Arno P ; van der Maaten, Joost ; Rosseel, Peter M ; Hofland, Jan ; Dieleman, Jan M ; Vinkers, Christiaan H ; Joëls, Marian ; van Dijk, Diederik ; Hillegers, Manon H ; DECS study group. / Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients. In: Journal of Affective Disorders. 2016 ; Vol. 206. pp. 216-223.
@article{4710720ca1754214a2c31c14fb560543,
title = "Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients",
abstract = "BACKGROUND: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.METHODS: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4{\%}) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.RESULTS: PTSD and depression symptoms were present in 10.2{\%} and 13.1{\%} of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.LIMITATIONS: The unequal distribution of male (78{\%}) and female patients (22{\%}) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.CONCLUSIONS: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.",
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author = "Lotte Kok and Sep, {Milou S} and Veldhuijzen, {Dieuwke S} and Sandra Cornelisse and Nierich, {Arno P} and {van der Maaten}, Joost and Rosseel, {Peter M} and Jan Hofland and Dieleman, {Jan M} and Vinkers, {Christiaan H} and Marian Jo{\"e}ls and {van Dijk}, Diederik and Hillegers, {Manon H} and {DECS study group}",
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year = "2016",
month = "12",
doi = "10.1016/j.jad.2016.07.020",
language = "English",
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pages = "216--223",
journal = "Journal of Affective Disorders",
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Kok, L, Sep, MS, Veldhuijzen, DS, Cornelisse, S, Nierich, AP, van der Maaten, J, Rosseel, PM, Hofland, J, Dieleman, JM, Vinkers, CH, Joëls, M, van Dijk, D, Hillegers, MH & DECS study group 2016, 'Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients' Journal of Affective Disorders, vol. 206, pp. 216-223. https://doi.org/10.1016/j.jad.2016.07.020

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients. / Kok, Lotte; Sep, Milou S; Veldhuijzen, Dieuwke S; Cornelisse, Sandra; Nierich, Arno P; van der Maaten, Joost; Rosseel, Peter M; Hofland, Jan; Dieleman, Jan M; Vinkers, Christiaan H; Joëls, Marian; van Dijk, Diederik; Hillegers, Manon H; DECS study group.

In: Journal of Affective Disorders, Vol. 206, 12.2016, p. 216-223.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

AU - Kok, Lotte

AU - Sep, Milou S

AU - Veldhuijzen, Dieuwke S

AU - Cornelisse, Sandra

AU - Nierich, Arno P

AU - van der Maaten, Joost

AU - Rosseel, Peter M

AU - Hofland, Jan

AU - Dieleman, Jan M

AU - Vinkers, Christiaan H

AU - Joëls, Marian

AU - van Dijk, Diederik

AU - Hillegers, Manon H

AU - DECS study group

N1 - Copyright © 2016 Elsevier B.V. All rights reserved.

PY - 2016/12

Y1 - 2016/12

N2 - BACKGROUND: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.METHODS: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.RESULTS: PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.LIMITATIONS: The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.CONCLUSIONS: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

AB - BACKGROUND: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.METHODS: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.RESULTS: PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.LIMITATIONS: The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.CONCLUSIONS: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

KW - Aged

KW - Anxiety/complications

KW - Depression/complications

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Personality

KW - Personality Inventory

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Factors

KW - Stress Disorders, Post-Traumatic/complications

KW - Stress, Psychological/complications

KW - Thoracic Surgical Procedures/psychology

U2 - 10.1016/j.jad.2016.07.020

DO - 10.1016/j.jad.2016.07.020

M3 - Article

VL - 206

SP - 216

EP - 223

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -