Highlights
- •Survivors of thrombotic thrombocytopenic purpura (TTP) have high rates of chronic morbidity.
- •Neurocognitive problems and depression are prominent in this patient population.
- •This study of TTP survivors demonstrates a high incidence of post-traumatic stress disorder.
- •The etiology and risk factors for PTSD in survivors of TTP remain uncertain.
Abstract
Introduction
Survivors of thrombotic thrombocytopenic purpura (TTP) have high rates of chronic
morbidities including neurocognitive complications and depression. There is limited
information regarding the psychological consequences of TTP. We conducted this cross
sectional study to estimate the prevalence of symptoms of PTSD and depression in survivors
of TTP.
Methods
An online survey tool comprising demographic and clinical information and two validated
self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression
Inventory-II (BDI-II), was distributed to individuals with TTP. Multivariable regression
was used to identify clinical and demographic associations of depression and PTSD.
Results
A total of 236 individuals completed either the BDI II or PCL-5 and were included
in the analysis. Median age was 44 years and 87.3% were female. Median time from diagnosis was 80 months. BDI-II scores >13 indicating at least mild depressive symptoms were present in 80.8% individuals
(15.8%, 28.2%, and 36.8% with mild, moderate and severe symptoms, respectively) and
35.1% had a positive screen for PTSD (PCL-5 score ≥ 38). A previous diagnosis of depression [OR 3.65 (95% CI 1.26–10.57); p = 0.017] and unemployment attributed to TTP [OR 5.86 (95% CI 1.26–27.09); p = 0.024] were associated with depression. Younger age (p = 0.017), a pre-existing anxiety disorder [OR 3.57 (95% CI 1.76–7.25), p < 0.001], and unemployment attributable to TTP [OR 6.42 (95% CI 2.75–415.00), p < 0.001] were associated with PTSD.
Conclusion
We report a high prevalence of PTSD and depression in TTP survivors. These results
are concerning and indicate a need for further investigation to better define this
association and its consequences.
Abbreviations:
TTP (thrombotic thrombocytopenic purpura), PTSD (post-traumatic stress disorder), DSM-5 (diagnostic and statistical manual of mental disorders), PCL-5 (post-traumatic stress disorder checklist for DSM-5), BDI-II (Beck Depression Inventory II), OR (odds ratio), IQR (interquartile range)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Thrombosis ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical practice. Thrombotic thrombocytopenic purpura.N. Engl. J. Med. 2006; 354: 1927-1935
- Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura.N. Engl. J. Med. 1991; 325: 393-397
- Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients.N. Engl. J. Med. 1991; 325: 398-403
- Survival and relapse in patients with thrombotic thrombocytopenic purpura.Blood. 2010; 115 (quiz 1662): 1500-1511
- Diagnostic and therapeutic challenges in the thrombotic thrombocytopenic purpura and hemolytic uremic syndromes.Hematology Am. Soc. Hematol. Educ. Program. 2012; 2012: 604-609
- Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura.Blood. 2013; 122 (quiz 2142): 2023-2029
- Increased morbidity during long-term follow-up of survivors of thrombotic thrombocytopenic purpura.Am. J. Hematol. 2015; 90E208
- Long term outcome and sequelae in patients after acute thrombotic thrombocytopenic purpura episodes.Hamostaseologie. 2013; 33: 113-120
- Cognitive deficits after recovery from thrombotic thrombocytopenic purpura.Transfusion. 2009; 49: 1092-1101
- Depression and cognitive impairment following recovery from thrombotic thrombocytopenic purpura.Am. J. Hematol. 2015; 90: 709-714
- Evidence of persistent neurologic injury following thrombotic thrombocytopenic purpura.Am. J. Hematol. 2011; 86: 87-89
- Long-term deficits in health-related quality of life after recovery from thrombotic thrombocytopenic purpura.Transfusion. 2009; 49: 118-124
- The cost of surviving thrombotic thrombocytopenic purpura: case report.J. Clin. Psychiatry. 1984; 45: 477-479
- A support group for patients who have recovered from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS): the six-year experience of the Oklahoma TTP-HUS study group.J. Clin. Apher. 2003; 18: 16-20
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J. Biomed. Inform. 2009; 42: 377-381
- The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation.J. Trauma. Stress. 2015; 28: 489-498
- Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation.Clin. Psychol. Rev. 1988; 8: 77-100
- Psychological Testing: History, Principles, and Applications.fifth ed. Pearson, Boston, MA2007
- Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.Arch. Gen. Psychiatry. 2005; 62: 617-627
- Posttraumatic stress disorder following medical illness and treatment.Clin. Psychol. Rev. 2003; 23: 409-448
- The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity.Soc. Sci. Med. 2000; 50: 1475-1484
- Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study.Lancet. Respir. Med. 2014; 2: 369-379
- Predicting post-traumatic symptoms in cardiac patients.Heart Lung. 2001; 30: 458-465
- Intrusive memories, post-traumatic stress disorder and myocardial infarction.Br. J. Clin. Psychol. 1999; 38: 411-416
- A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI).Gen. Hosp. Psychiatry. 2001; 23: 215-222
- Posttraumatic stress disorder and health-related quality of life in patients with coronary heart disease: findings from the heart and soul study.Arch. Gen. Psychiatry. 2009; 66: 1214-1220
- Does post-traumatic stress disorder occur after stroke: a preliminary study.Int. J. Geriatr. Psychiatry. 1998; 13: 315-322
- Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks.Stroke. 2012; 43: 2192-2197
- Correlates of post-traumatic stress disorder in stroke survivors.J. Stroke Cerebrovasc. Dis. 2014; 23: 1099-1105
- Variceal haemorrhage and post-traumatic stress disorder.Br J Clin Psychol. 1999; 38: 203-208
- Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.Crit. Care Med. 1998; 26: 651-659
- Psychological problems following ICU treatment.Anaesthesia. 2001; 56: 9-14
- Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care.Crit. Care Med. 2001; 29: 573-580
- Overdiagnosis of depression in the medically ill.Am. J. Psychiatry. 1987; 144: 125-126
- Posttraumatic stress disorder: epidemiology and health-related considerations.The Journal of Clinical Psychiatry. 2000; 61: 5-13
- Biomarkers of PTSD: neuropeptides and immune signaling.Neuropharmacology. 2012; 62: 663-673
- Altered blood coagulation in patients with posttraumatic stress disorder.Psychosom. Med. 2006; 68: 598-604
- Measures of endothelial dysfunction in plasma of patients with posttraumatic stress disorder.Psychiatry Res. 2008; 158: 363-373
- Post-traumatic stress disorder: a fast track to premature cardiovascular disease?.Cardiol. Rev. 2013; 21: 16-22
- Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women.Circulation. 2015; 132: 251-259
- The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women.JAMA Psychiat. 2014; 71: 44-51
- Quality-of-life impairment in depressive and anxiety disorders.Am. J. Psychiatry. 2005; 162: 1171-1178
- “Post-thrombotic panic syndrome”: a thematic analysis of the experience of venous thromboembolism.Br. J. Health Psychol. 2016;
- Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.BMJ Open. 2014; 4e004561
- Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II.Clinics. 2013; 68 (Sao Paulo): 1274-1287
- Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans.Psychol. Assess. 2015;
- Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma.Arch. Gen. Psychiatry. 1998; 55: 626-632
- The epidemiology of posttraumatic stress disorder: what is the extent of the problem?.J. Clin. Psychiatry. 2001; 62: 16-22
- Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies.Eur. Arch. Psychiatry Clin. Neurosci. 2002; 252: 201-209
Article info
Publication history
Published online: January 06, 2017
Accepted:
January 5,
2017
Received in revised form:
December 19,
2016
Received:
October 5,
2016
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
