PTSD doesn't just affect war veterans—it can be triggered by critical illness

Post-traumatic stress disorder (PTSD) is a form of chronic psychological distress that follows exposure to a traumatic event. It's most often associated with survivors of military combat, terrorist attacks, natural disasters, or sexual assault.

But PTSD isn't limited to people who've been exposed to physically threatening situations. Individuals who experience serious or life-threatening medical events can be susceptible to PTSD, too.

This isn't a surprise to experts: Past studies have shown evidence of PTSD symptoms among people who've been treated for cancer, heart attacks and stroke as well as organ transplant patients. But PTSD may go unrecognized in many patients and can sometimes slow recovery from a critical illness.

What we know now

A number of studies have added to a growing body of PTSD research. Below are just a few health-related triggers that are associated with PTSD.

  • Heart attack. One in eight persons who have a heart attack or other acute coronary emergency develops PTSD symptoms, according to researchers who analyzed data from 24 PTSD studies that included 2,383 heart patients. The analysis, published in June 2012 by the journal PLOS One, noted that the risk of having a second heart attack or dying among heart patients with PTSD doubles within three years.
  • Stroke. Eighteen percent of stroke and mini-stroke survivors reported symptoms of PTSD in a study published online in January 2013 by the British Journal of Health Psychology. Sixty-five percent of those patients with PTSD symptoms were less likely to follow their drug regimen—perhaps because it reminded them of their stroke—putting them at risk for another stroke.
  • Breast cancer. Nearly one in four women with breast cancer developed PTSD symptoms within the first two to three months after diagnosis, says a study published online in February 2013 by the Journal of the National Cancer Institute. Symptoms were most common in African American and Asian women and women under 50.
  • Spine surgery. In a study of 73 patients who underwent elective lumbar spinal fusion surgery—a procedure that fuses together two or more vertebrae—nearly one in five had PTSD symptoms within one year of surgery. Patients who had pre-surgery depression or anxiety were most likely to develop PTSD.
  • Hospitalization in an intensive care unit (ICU). One in three patients admitted to an ICU with an acute lung injury and placed on a ventilator to aid in breathing had PTSD symptoms up to two years after their stay, according to a recent meta-analysis conducted by Johns Hopkins and published online in March 2013 by Psychological Medicine. The Hopkins doctors suspect that PTSD is common among other ICU patients as well.
  • Overcrowded emergency rooms. In a small study, people who spent more than 11 hours waiting in a busy emergency department to be treated for chest pain or a heart attack were more likely to show signs of PTSD. Being in such a situation heightens stress, say researchers, whose findings were reported online in February 2013 by JAMA Internal Medicine.

Doctor's Viewpoint

Peter V. Rabins, MD, MPH Professor, Psychiatry & Health Policy, Co-Director, Division of Geriatric Psychiatry & Neuropsychiatry, Johns Hopkins Medicine

Experiencing distress following a medical event is normal, but if your symptoms persist for more than a month and are interfering with your well-being, you should be screened for PTSD.

Doctors need to pay special attention to individuals with PTSD risk factors or coexisting conditions, such as depression,anxiety, a history of substance abuse, low socioeconomic status, poor social support or parental neglect, and respond accordingly. Early recognition of PTSD can help reduce its symptoms and ensure they don't interfere with recovery from the associated illness.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 05 Aug 2013

Last Modified: 13 Feb 2015