Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

Lotte Kok*, Milou S. Sep, Dieuwke S. Veldhuijzen, Sandra Cornelisse, Arno P. Nierich, Joost van der Maaten, Peter M. Rosseel, Jan Hofland, Jan M. Dieleman, Christiaan H. Vinkers, Marian Joels, Diederik van Dijk, Manon H. Hillegers, DECS Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Scopus)


Background: Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.

Methods: Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.

Results: PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.

Limitations: The unequal distribution of male (78%) and female patients (22%) might limit the general-izability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.

Conclusions: In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery. (C) 2016 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)216-223
Number of pages8
JournalJournal of Affective Disorders
Publication statusPublished - Dec-2016
Externally publishedYes


  • Post-traumatic stress disorder
  • Depression
  • Intensive care unit
  • Cardiac surgery
  • Trait anxiety
  • Childhood trauma

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