Abstract

Post-traumatic stress disorder as a result of a heart attack has been thoroughly researched in recent years due to its significant effect on heart disease patients (Shemesh, et al., 2004). Individuals suffering from post-trauma following a heart attack experience a low quality of life (Gamper et al., 2004), social difficulties (Doerfler, Pbert & Decosimo, 1994) as well as anxiety and depression (Doerfler & Paraskos, 2011). Furthermore, post-traumatic stress disorder in heart disease patients reduces their adherence to medical treatment and therefore increases their risk of re-hospitalization (Shemesh et al., 2004).

The vast amount of research that has been done in the field of  health psychology reveals that coping with heart disease does not concern the patient only, but also  the patient's family, and in particular the patient's spouse, who is often deeply affected by both the patient's heart disease and his/her post-traumatic stress disorder. For example, studies indicate that spouses of heart disease patients experience significant negative emotional symptoms such as helplessness, lack of control, anxiety and depression (Randall, Molloy & Steptoe, 2009). It should be noted as well that research on female spouses of soldiers suffering from post-traumatic stress disorder also revealed significant anxiety in spouses (Dekel, et al., 2004).

According to definitions offered by the DSM-5 (American Psychiatric Association, 2013), spouses of heart disease patients may  themselves develop primary PTSD:  by witnessing an event during which  their spouse suffered a loss of consciousness, by seeing their spouse being treated medically during a life-threatening event, or even  by learning subsequently that the disease caused significant cardiac damage to their spouse.  In addition people who are in close contact with the patient may also experience emotional distress and may even develop “secondary traumatization” (Figley, 1983), a concept which relates to the emotional and behavioral effects experienced by the significant other, and the stress resulting from helping or wanting to help the traumatized person (Figley, 1955). Nevertheless, the unique experiences of spouses whose partners have been traumatized as a result of their heart disease have not yet been studied.

This study aims to shed light on the experiences of spouses living with heart disease patients who have presented post-traumatic stress symptoms as a result of their heart attacks. The study sought to understand whether the spouses suffered from either secondary traumatization or post-traumatic stress disorder and how the trauma was expressed in their personal lives. The researchers used the qualitative narrative paradigm based on the individual as a main tool to understand the unique human experiences of the participants (Shkedi, 2011).

Nine spouses (eight females and one male) of heart disease patients with significant post-traumatic stress symptoms as a result of their heart attacks were interviewed via a semi-structured interview. Patients and their spouses filled in the Primary Care Post-Traumatic Stress Disorder screening questionnaire (PC-PTSD), a questionnaire aimed to assess the number of post-traumatic symptoms they had experienced. Participants were interviewed within two to six months after their partners' heart attack. The interviews were assessed in two ways.  In the first part, in order to understand the subjective experiences of the participants, a categorical analysis approach was used (Leiblich, Tuval-Mashiach & Zilber, 2010).  In the second part, in order to distinguish between a diagnosis of   PTSD and a diagnosis of secondary traumatization, a theory-based reading was used (Leiblich, Tuval-Mashiach & Zilber, 2010).

Research findings revealed that spouses tended to experience post-traumatic stress symptoms such as negative emotional and cognitive changes, intrusiveness, stress and over-arousal. However, the screening questionnaire revealed that only two females out of a total of nine participants were diagnosed as suffering from significant traumatic symptoms. Additional significant findings related to the toll that the disease and the trauma took on the couple, revealing changes that had occurred in role patterns and physical closeness between the spouses. Results also shed light on spouses' coping mechanisms.

The present study revealed negative emotional changes and significant levels of anxiety leading to less activity and over-protection on the part of spouses. High levels of anxiety in spouses may have been a result of their need to cope with two factors: the consequences of their partners' heart attack and also their partners' post traumatic experiences. Therefore, the anxiety they felt, although often followed by a sense of purposefulness and action, was intense and affected them profoundly.

Furthermore, spouses describing symptoms of intrusiveness mainly reported experiencing negative thoughts, mental distress and even painful memories. Some of them claimed that physiological heart attack symptoms in their partners led to their own distress and intrusive thoughts.

 

PTSD, Couples, and Cardiac Illness Study