Posttraumatic stress disorder (PTSD) in a sample of patients evaluated for acute coronary syndrome: A factor analysis of the PTSD checklist for DSM-5 (PCL-5)

The PCL-5 is a psychometrically sound measure of Post-Traumatic Stress Disorder (PTSD) symptoms. Although the scale is commonly applied to past external traumas (e.g., combat, assault), PTSD symptoms have also been assessed about potentially life-threatening cardiovascular events that represent ongoing internal threats. To date, there is a paucity of studies that have examined the updated scale factor structure for PTSD in patients with suspected acute coronary syndromes (ACS). Methods: Exploratory and confirmatory factor analyses (EFA, CFA) were conducted using PCL-5 data completed by 830 patients enrolled in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Follow-up measurement invariance tests were conducted on pre-selected models and on the best-fitting model identified by EFA to evaluate invariance across diagnosis (confirmed v. rule-out ACS), sex, and language. Results: The EFA identified a two-factor model with "Memories of Trauma" (MT) and "Cognitive Behavioral Symptoms" (CBS) factors offering a balanced fit and interpretability. In CFAs, the Anhedonia CFA model performed the best overall. Measurement invariance tests supported strong invariance across confirmed and ruled- out ACS, male and female sex, and English and Spanish language for all models. Limitations: Only 34 % of the sample was diagnosed with ACS at discharge, which limits generalizability. Conclusion: Our study contributes to the understanding of PTSD in the context of internal traumatic reminders and may guide future research and clinical practice by informing intervention targets to improve health and wellbeing after suspected ACS.