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Patient Evidence Summary
Doctor, I was diagnosed with a blood clot in my lungs over a year ago. Is it normal to still have anxiety about it now?
Being diagnosed with a PE is a stressful event for most people. Anxiety about having another PE or other symptoms of psychological distress are common. However, if your distress is significant enough to interfere with your daily life, you should speak with your doctor. Patient support groups such as the North American Thrombosis Forum (https://natfonline.org/patients/support-groups/) are helpful for some people.
Study highlights
*this is a small study at a single centre (the results might be different with a larger study)
When questioned an average of one year after their PE, about half of the study participants reported some degree of psychological distress. Two participants had a high enough level of psychological distress that they could be considered to have post-traumatic stress disorder.
How the diagnosis of PE is delivered by health care providers is one of the factors that may have a long-lasting impact on the psychological distress of patients.
Understanding the problem
People who are diagnosed with PE often experience symptoms like chest pain and shortness of breath. Even after the physical symptoms improve, the negative emotional or psychological impact of PE can linger for a long time. Anxiety about having another PE is common, but some people experience such severe anxiety or depression, they are unable to return to living their usual lives. Symptoms like flashbacks and hypervigilance, where they are constantly watching for symptoms that could be due to a new PE, can become very intrusive. Similar symptoms can also occur in people who have post-traumatic stess disorder. Post-traumatic stress disorder is a psychiatric condition that can occur in people who have experienced a traumatic event.
The investigators in this study wanted to know how often people with PE have psychological distress that is severe enough to be considered post-traumatic stress disorder and to understand which factors might contribute to this problem.
Who? The study included 72 people (age 28 to 85 years) who had been diagnosed with PE one year earlier. Almost half of them also had cancer (which means they had additional reasons to have concerns about their health). Thirty-seven participants agreed to interviewed.
What? The study used the combination of a questionnaire and interview to assess if participants suffered from post-traumatic stress disorder and to determine which factors were linked to psychological distress.
Questionnaire | Semistructured interviews | |
|---|---|---|
Participants used a tablet computer to rate how much they agreed with statements about anxiety, low mood, coping, and worry on a scale of 0 to 100 (0 = completely disagree and 100 = completely agree) Participants were also asked questions based on a checklist for post-traumatic stress disorder and based on their responses, were given a score of 0 to 80. The score considered consistent with post-traumatic stress disorder is 33 or higher. | Participants were interviewed by one of the researchers. They were asked questions about five main topics: their experience of receiving a PE diagnosis, psychological impact following diagnosis, lifestyle changes following diagnosis, changes in outlook on life, and past or current treatment. Interviews lasted an average of 30 minutes. Researchers looked for patterns (themes) of similar answers between participants. |
Adults diagnosed with PE who were treated at a hospital Thrombosis clinic
Outcomes | Result |
|---|---|
I feel more anxious since my PE diagnosis | 24% of participants agreed with this statement |
Post-traumatic stress disorder checklist score | Average score 9 (ranging from 0 to 40 out of 80) 24% participants had a score of 0 A score of 33 is considered consistent with post-traumatic stress disorder (2 participants had scores that reached this cut point) |
| Themes from interviews that were linked to ongoing psychological distress | Having a healthcare provider describe their PE as potentially fatal or commenting that they were lucky to survive was associated with increased anxiety Worrying about a new PE when advised to stop anticoagulant treatment by a health care provider was associated with increased anxiety |
This Evidence Summary is based on the following article:
Tran A, Redley M, de Wit K. The psychological impact of pulmonary embolism: A mixed-methods study. Res Pract Thromb Haemost. 2021 Jan 28;5(2):301-307. doi: 10.1002/rth2.12484. eCollection 2021 Feb. PubMed
Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Dr. Linkins is an Associate Professor of Medicine (thrombosis) at McMaster University in Hamilton, Canada. She holds a Masters Degree in Health Research Methodology and is a Deputy Editor with the Health Information Research Unit, McMaster. She is Co-Editor of the ACP Journal Club and Co-lead on the CanVECTOR Knowledge Translation Platform.
Published: Tuesday, December 21, 2021
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
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, McMaster University