**3. Results and discussion**

248 Post Traumatic Stress Disorders in a Global Context

physical integrity" (Criterion A1) and is associated with feelings of intense fear, helplessness or horror (Criterion A2). The symptoms includ "persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D)". In addition, these symptoms must be present for at least one month (Criterion E) and have a significant negative impact on social, occupational or other areas of functioning (Criterion F). Research on PTSD has traditionally focused on traumas such as war, physical and sexual assaults, and road traffic accidents (Shalev et al., 1993). However, there has been growing recognition that PTSD symptoms may occur after a range of medical events (Tedstone & Tarrier, 2003), including cancer (e.g., Kangas et al., 2005), myocardial infarction (MI) (e.g., Kutz et al., 1994), and subarachnoid haemorrhage (e.g., Berry, 1998). Accordingly, life-threatening illnesses were added as an example of a traumatic event that

The experience of PTSD after stroke may have important implications for recovery. For example, PTSD has been related to poorer physical health in the general population (Spitzer et al., 2009) as well as to non-adherence to medication and adverse clinical outcomes in MI patients (Shemesh et al., 2001), worse functional recovery in patients with severe traumatic brain injury (Bryant et al., 2001), and higher levels of disability following hospitalization for physical injuries (e.g., resulting from road traffic accidents) (O'Donnell et al., 2009). PTSD is also likely to have a negative impact on stroke rehabilitation (Williams, 1997). First, the experience of intrusions may place high demands on the already limited cognitive resources of many stroke survivors, which may further restrict their ability to fully process, and come to terms with, the trauma experience. Second, survivors with PTSD are likely to try to avoid reminders of the stroke, which may hinder attempts to integrate them back into the community. Third, survivors with PTSD are likely to engage in catastrophic thinking and to have excessively negative perceptions of possible future harm which may further impede

Previous reviews have focused on the prevalence and correlates of PTSD following a range of life-threatening physical illnesses (e.g., Pedersen, 2001; Spindler & Pedersen, 2005; Tedstone & Tarrier, 2003). However, these reviews have either been very general in their scope (e.g., Tedstone & Tarrier, 2003) or have focused on specific medical conditions other than stroke (e.g., Spindler & Pedersen, 2005). In relation to the psychological consequences of stroke, reviews to date have only focused on the prevalence (Hackett et al., 2005) and the correlates (Hackett & Anderson, 2005) of depression after stroke. The main aims of the current review were to (i) assess the prevalence of PTSD after stroke, (ii) identify the main correlates of PTSD after stroke, (iii) highlight a range of methodological issues in research on

The following electronic databases were searched in order to identify relevant studies to include in the review: Web of Knowledge, PsycINFO, and Medline. The searches were restricted to studies published between 1994 (the year life-threatening illnesses were included as an example of a traumatic event in the DSM) and May 2011. The following search terms were used: (i) stroke and cerebrovascular accident, and (ii) post-traumatic stress disorder, posttraumatic stress disorder, PTSD, Impact of Events Scale, IES, Penn, Post

PTSD after stroke, and (iv) make recommendations for future research.

may lead to the development of PTSD in DSM-IV (APA, 1994).

rehabilitation efforts.

**2. Methods** 
