Ackerman MG, Shapiro PA. Psychological effects of invasive cardiac surgery and cardiac transplantation. In: Alvarenga ME, Byrne D (eds). Singapore: Springer Singapore; 2016

Diagnostic and statistical manual of mental disorders (DSM-5), 5th edn. Washington (DC): APA; 2013

PTSD and cardiac surgery: a randomised, controlled pilot study to assess the effect of a brief psychoeducational intervention: a thesis presented in partial fulfilment of the requirements for the degree of master of arts in psychology at Massey University, Auckland, New Zealand. 2014. (accessed 23 June 2021)

Bhuvaneswar CG, Ruskin JN, Katzman AR, Wood N, Pitman RK. Pilot study of the effect of lipophilic vs. hydrophilic beta-adrenergic blockers being taken at time of intracardiac defibrillator discharge on subsequent PTSD symptoms. Neurobiol Learn Mem.. 2014; 112:248-252

Bluvstein I, Moravchick L, Sheps D, Schreiber S, Bloch M. Posttraumatic growth, posttraumatic stress symptoms and mental health among coronary heart disease survivors. J Clin Psychol Med Settings.. 2013; 20:(2)164-172

Boyer BA, Matour SJ, Crittenden KB, Larson KA, Cox JM, Link DD. Appraisals of fear, helplessness, and perceived life-threat during emergent cardiac surgery: relationship to pre-surgical depression, trauma history, and posttraumatic stress. J Clin Psychol Med Settings.. 2013; 20:(2)173-185

Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behav Res Ther.. 2003; 41:(12)1489-1496

Davydow DS, Zatzick D, Hough CL, Katon WJ. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical–surgical intensive care unit admission. Gen Hosp Psychiatry.. 2013; 35:(3)226-232

Doerfler LA, Paraskos JA. Posttraumatic stress disorder following myocardial infarction or cardiac surgery. In: Allen R, Fisher J (eds). Washington (DC): American Psychological Association; 2011

Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM. Posttraumatic stress disorder and risk for coronary heart disease: A meta-analytic review. Am Heart J.. 2013; 166:(5)806-814

Gold PW. The organization of the stress system and its dysregulation in depressive illness. Mol Psychiatry.. 2015; 20:(1)32-47

Gražulytė D, Kazlauskas E, Norkienė I Long-term quality of life and posttraumatic stress following elective cardiac surgery: preliminary findings of a 5-year follow-up study. Acta Med Litu.. 2019; 26:(1)87-92

Hauer D, Kolassa IT, Laubender RP A genotype-specific, randomized controlled behavioral intervention to improve the neuroemotional outcome of cardiac surgery: study protocol for a randomized controlled trial. Trials.. 2013; 14:(1)

Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med.. 1979; 41:(3)209-218

Kok L, Sep MS, Veldhuijzen DS Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients. J Affect Disord.. 2016; 206:216-223

Krauseneck T, Padberg F, Roozendaal B A beta-adrenergic antagonist reduces traumatic memories and PTSD symptoms in female but not in male patients after cardiac surgery. Psychol Med.. 2010; 40:(5)861-869

Marke V, Bennett P. Predicting post-traumatic stress disorder following first onset acute coronary syndrome: testing a theoretical model. Br J Clin Psychol.. 2013; 52:(1)70-81

Paulus EJ, Argo TR, Egge JA. The impact of posttraumatic stress disorder on blood pressure and heart rate in a veteran population. J Trauma Stress.. 2013; 26:(1)169-172

Shdaifat SA, Al Qadire M. Anxiety and depression among patients admitted to intensive care. Nurs Crit Care.. 2020;

Stoll C, Schelling G, Goetz AE Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg.. 2000; 120:(3)505-512

Tagay S, Herpertz S, Langkafel M, Senf W. Trauma, posttraumatische belastungsstörung und somatisierung. [Trauma, post-traumatic stress disorder and somatization]. PPmP-Psychotherapie· Psychosomatik· Medizinische Psychologie.. 2004; 54:(05)198-205

Tulloch H, Greenman P, Tassé V. Post-traumatic stress disorder among cardiac patients: Prevalence, risk factors, and considerations for assessment and treatment. Behav Sci (Basel).. 2014; 5:(1)27-40

Tully PJ. Quality-of-Life measures for cardiac surgery practice and research: a review and primer. J Extra Corpor Technol.. 2013; 45:(1)8-15

Wade D, Hardy R, Howell D, Mythen M. Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol.. 2013; 79:(8)944-963

Weiss DS. The impact of event scale: revised. In: Wilson JP, Tang CS-k (eds). New York (NY): Springer; 2007

Prevalence of post-traumatic stress disorder and its predictors following coronary artery bypass graft surgery

08 July 2021
Volume 30 · Issue 13



Cardiac surgery can be traumatic and stressful, and as a result many people experience psychological difficulties following treatment.


To assess the level of post-traumatic stress disorder (PTSD) 1 month after coronary artery bypass graft (CABG) surgery among Jordanian patients, and to examine the predictors of PTSD after 1 month.


A descriptive survey design was used.


149 patients participated in the study. Their mean age was 59 years (SD=10.2) and most were male (87%) and married (93%). Some 44% of patients had PTSD. Length of stay in hospital (c² (1)=6.598, P<0.05), and age (c² (1)=4.920, P<0.05), predicted the occurrence of PTSD after 1 month.


Nurses, who are usually in the frontline with patients, should consider using a robust tool and clinical interview to assess and evaluate the presence and the risks of PTSD to promote early detection and optimal management. Follow-up studies after 6 and 12 months would be beneficial.

Post-traumatic stress disorder (PTSD) is a complex condition that results from exposure to a traumatic events (American Psychiatric Association (APA), 2013). According to the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) (APA, 2013), a diagnosis of PTSD is made when the symptoms persist for more than 1 month after the traumatic event. These events include, but are not limited to, armed struggle, physical assault, sexual violence, kidnapping, terror attacks, torture, natural or man-made disasters, motor vehicle accidents or life-threatening illness. Having a life-threatening illness might not necessarily be considered a traumatic event, although incidents related to the illness, which may be sudden or tragic, can be triggered by it (APA, 2013).

Individuals with PTSD experience several distressing symptoms, classified into three categories: re-experiencing symptoms such as intrusive thoughts, nightmares or flashbacks; avoiding stimuli or reminders of the event; and physiological arousal (for example, hypervigilance, exaggerated startle response) (APA, 2013). Sensory disturbances can be distressing and have been associated with prolonged psychological distress and heightened physiological arousal (Kok et al, 2016). Individuals with PTSD often limit their social interactions, affecting their quality of life and psychosocial outcomes (APA, 2013). They may also experience reduced interest in usual activities and persistent anhedonia, and engage in irresponsible behaviours such as drug use or excessive alcohol consumption (APA, 2013). Further disability is seen in social and family relationships, work attendance, income status, occupational success, education levels and general quality of life (Hauer et al, 2013).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content