Stroke survivors with post-traumatic stress disorder (PTSD) are less likely to adhere to treatment regimens that reduce the risk of an additional stroke, according to a new study.
A team led by researchers from Columbia University Medical Center found that 65 percent of stroke survivors with PTSD failed to adhere to treatment, compared with 33 percent of those without PTSD.
The study also suggests that non-compliance in PTSD stroke patients is partly explained by increased ambivalence toward medication.
Among stroke survivors with PTSD, approximately one in three — 38 percent — had concerns about their medications, according to the researchers.
According to data from the American Stroke Association, nearly 795,000 Americans suffer a stroke each year, making it the fourth-leading cause of death and the top cause of disability in the United States.
Survivors are often prescribed treatment regiments, including antiplatelet agents, antihypertensive agents, and statins, which help reduce the risk of subsequent strokes. Previous research has shown that PTSD triggered by medical events — which affects 18 percent of stroke survivors — can hinder recovery.
“Unfortunately, too many stroke survivors are not compliant with these regimens, even though we know that adherence to post-stroke treatment regimens is one of the most important components of reducing the risk of a future stroke,” said Ian M. Kronish, MD, MPH, assistant professor of medicine at Columbia University and one of the study’s authors.
“For those with PTSD, this study shows that concerns about medications are a significant barrier to treatment adherence,” he continued.
“Stroke survivors should be assessed for concerns about medications and PTSD symptoms, so that interventions may be introduced as early as possible to get patients back on track to avoid future stroke events.”
The researchers asked 535 stroke survivors about PTSD symptoms, adherence to medications, and beliefs or concerns about medications. The survivors were recruited between March 2010 and January 2012 in clinical trials in Harlem and the Bronx. Average time since the stroke or transient ischemic attack (TIA) among subjects was nearly 2 years.
Compared with stroke patients without PTSD symptoms, patients with PTSD felt more ambivalence toward medication, worried more about the long-term effects of medication, and complained about the way medication disrupted their lives, according to the researchers.
Additionally, PTSD was associated with an increased belief in the general harm and overuse of medications in the medical system, researchers note.
Previous research with the same cohort found that stroke survivors with the most severe PTSD symptoms were nearly three times as likely as those without PTSD to be nonadherent to medications.
“We believe that these findings suggest that stroke survivors with PTSD do not see their medications as helpful, but rather as reminders of their stroke, and that they avoid taking them as a way to avoid thinking about their stroke,” said Donald Edmondson, PhD, assistant professor of behavioral medicine and first author of the paper.
“We need to conduct further research to determine whether treating a stroke survivor for PTSD would alleviate medication concerns that lead to avoidance, or if additional interventions should be designed to address both issues.”
The study was published in the British Journal of Health Psychology.