Feb 13 Being treated for a heart attack in a crowded emergency department may be linked to developing symptoms of post-traumatic stress disorder (PTSD), according to a U.S. study.
Previous research has found that about one in eight heart attack patients develop PTSD symptoms, which were tied to the risk of having a second heart attack and dying within three years.
The study, which appeared in JAMA Internal Medicine, doesn't prove that crowded emergency rooms cause stress disorders, but researchers suggested that their findings show that hospital environments may leave a mark on patients' mental health.
"What we're showing here is - aside from the severity of a heart attack - the emergency department itself can carry forward and impact a person's psychological adjustment after," said lead author Donald Edmondson, from Columbia University Medical Center in New York.
Other studies have linked heart attacks and PTSD but the researchers wrote that they haven't looked at whether the hospital environment was tied to the disorder's start.
In 2009, a survey found that over 90 percent of U.S. emergency room (ER) directors said overcrowding is a problem at their hospitals several times per week. They said it led to increased wait times, and it was tied to dissatisfied patients and a higher risk of poor outcomes.
"If you go to an urban emergency department on a busy evening, you may have patients piled up in the hallway, patients with substance abuse problems and patients who are mentally ill," said Benjamin Sun, who studies hospital overcrowding but was not involved with the new study.
"If you are a patient who is very sick and you are getting care under those conditions, you can see why you'd be traumatized."
For the study, Edmondson and his colleagues used data collected from medical records and interviews with 135 heart attack patients at one New York City hospital between 2009 and 2011. On the least busy days, an average of 199 people passed through the ER, compared to an average of 255 on the busiest.
Heart attack patients who were there on the least busy days scored a 3 on a test that measures PTSD symptoms on a scale from 0 to 88, with higher scores being more severe forms of the disorder. Patients there on the busiest days scored an 8.
Edmondson told Reuters Health that neither group scored high enough to be diagnosed with PTSD, but it's enough of a difference for patients to notice.
Sun said he wasn't surprised and thought there were several possible explanations, such as patients picking up on how stressed doctors and nurses are at busier times.
Edmondson said that patients may also see or experience a breakdown in communication between nurses and doctors, which can happen in crowded ERs.
He told Reuters Health that the next step is to look at the problem in a larger group of patients at several hospitals, and that there may be a link between PTSD and other types of patients as well.
"I don't think there is anything special in heart attack patients that makes emergency departments more likely to cause PTSD," he said. SOURCE: bit.ly/WhLRfj (Reporting from New York by Andrew Seaman at Reuters Health; editing by Elaine Lies)