The study was conducted in colloboration at the Stroke Unit / Intermediate Care Unit of Klinikum Forchheim - Fränkische Schweiz gGmbH between 2017-2018.
The Klinkum Forchheim is a medium-sized general hospital in Franconia, Germany. The study was approved by the Ethics Committee of the University of Oldenburg (Registration-Nr.: 2016-169) and performed in accordance with the ethical standards as set forth in the Declaration of Helsinki and its later amendments. The study is registered in the German Clinical Trials Register (DRKS00021730). We examined 66 consecutive patients hospitalised at stroke unit / intermediate care unit due acute ischaemic or hemorrhagic stroke. All subjects gave their written informed consent prior to their voluntary participation in the study. In total, 53 patients were included in the study after we excluded patients due to severe cognitive impairment (n = 7), missing capacity to provide informed consent due to aphasia (n = 5) or previous PTSD (n=1).
The following questionnaires and scoring systems were used:
Primary Care-PTSD Screen (PC-PTSD)
The German version of the Primary Care-PTSD Screen (PC-PTSD) was used to assess the occurrence of PTSD symptoms. The PC-PTSD is a validated brief 4-item instrument developed by the Veteran’s Administration to screen for PTSD in primary care settings . It asks: “In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month you…” This statement is followed by four items that broadly correspond to above mentioned DSM-V diagnostic criteria: intrusion; avoidance, hyperarousal and numbness or detachment (from others, activities, or surroundings). A binary cut-off score of >2 was used in our study .
Hospital Anxiety and Depression Scale (HADS)
The degree of depression and anxiety during the preceding week was assessed using the German version of the hospital anxiety and depression scale (HADS) . Separate anxiety and depression subscale scores can be assessed. HADS scores were categorised as normal (0–7), borderline abnormal (8–10) and abnormal (11–21) .
Short Form (SF)-12
Quality of life (HRQoL) was assessed using the german version of the Short Form (SF)-12 questionaiere. The SF-12 uses only 12 of the 36 questions from the SF-36, and the 12 questions can be abstracted from the answers provided in the SF-36 . The 12 items are aggregated into two health summary scales that reflect physical (PCS) and mental (MCS) components ranging from 0 (worst) to 100 (best). The component scores for the SF-12 are norm-based, with a mean score of 50 and standard deviation of ± 10. A higher score reflects better HRQoL and a lower score, poorer HRQoL .
Brief COPE Inventory (COPE)
The German version of the brief COPE Inventory was applied to assess patient’s disposition for using maladaptive coping strategies . The sum of maladaptive coping strategy scores (denial, substance use, behavioural disengagement, self-distraction, self-blame) was assessed as an indicator of maladaptive coping. The sum of the adaptive coping strategy scores (active coping, emotional support, expression of emotions, instrumental support, positive reinterpretation, planning, humor and acceptance) was assessed as an indicator of adaptive coping. The higher the maladaptive or adaptive coping test score, the more patients habitually use maladaptive or adaptive coping strategies, respectively .
We assessed clinical stroke severity by means of the NIHSS (ranging from 0-42 points)  on admission and on discharge. Moreover, all patients received a questionnaire to assess sociodemographic data and information about their medical history, i.e. previous stroke/TIA, rheumatic disease, diabetes mellitus (DM), coronary artery disease, dementia, thyroid disease or cancer.
For data analysis, we used a commercially available statistical program (SPSS™ 21.0, SPSS Inc., Chicago, IL). Data were tested for normal distribution using the Shapiro-Wilk test. For comparison of the NIHSS, PTSD-like symptoms, HADS depression and anxiety score, SF-12 and COPE between patients with TIA and patients with stroke, we used the Mann–Whitney U-test. For dichotomous parameters, such as presence or absence of previous stroke/TIA, rheumatic disease, diabetes, coronary artery disease, dementia, thyroid disease or cancer, psychopharmacotherapy on admission and discharge, PTSD-like symptoms, normal, borderline abnormal and abnormal test results in the HADS in patients with TIA and patients with stroke, we used Chi-squared test or Fisher exact test as appropriate. Correlation between NIHSS scores and the different psychometric assessment results was assessed with the Spearman rank correlation test. We used an adjusted binary logistic regression analysis to calculate the odds ratios and 95% confidence intervals of PTSD-like symptoms with previous psychiatric disorders and sociodemographic data as covariates.