This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (147)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Stress  • Alert me on articles by topic

Arieh Y. Shalev, MD; Tali Sahar, MSc; Sara Freedman, MA; Tuvia Peri, PhD; Natali Glick, MD; Dalia Brandes, MSc; Scott P. Orr, PhD; Roger K. Pitman, MD

Arch Gen Psychiatry. 1998;55:553-559.

Background  Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD.

Methods  Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. Heart rate and blood pressure were recorded on arrival at the emergency department. Heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months.

Results  Twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5±13.9 vs 83.3±10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8±11.9 vs 72.0±9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event.

Conclusion  Elevated heart rate shortly after trauma is associated with the later development of PTSD.

From The Center for Traumatic Stress, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel (Drs Shalev, Peri, and Glick and Mss Sahar, Freedman, and Brandes); and Manchester Veterans Affairs Research Service, Harvard Medical School, Manchester, NH (Drs Orr and Pitman).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Terrorism, Acute Stress, and Cardiovascular Health: A 3-Year National Study Following the September 11th Attacks
Holman et al.
Arch Gen Psychiatry 2008;65:73-80.
ABSTRACT | FULL TEXT  

Somatic Experiencing Treatment With Tsunami Survivors in Thailand: Broadening the Scope of Early Intervention
Leitch
Traumatology 2007;13:11-20.
ABSTRACT  

Post-traumatic stress disorder
Bisson
Occup Med (Lond) 2007;57:399-403.
ABSTRACT | FULL TEXT  

Parental Posttraumatic Stress Symptoms as a Moderator of Child's Acute Biological Response and Subsequent Posttraumatic Stress Symptoms in Pediatric Injury Patients
Nugent et al.
J Pediatr Psychol 2007;32:309-318.
ABSTRACT | FULL TEXT  

Tonic and Phasic Heart Rate as Predictors of Posttraumatic Stress Disorder
O'Donnell et al.
Psychosom. Med. 2007;69:256-261.
ABSTRACT | FULL TEXT  

Physiologic Reactivity Despite Emotional Resilience Several Years After Direct Exposure to Terrorism
Tucker et al.
Am. J. Psychiatry 2007;164:230-235.
ABSTRACT | FULL TEXT  

Emotional or educational debriefing after psychological trauma: Randomised controlled trial
Sijbrandij et al.
Br. J. Psychiatry 2006;189:150-155.
ABSTRACT | FULL TEXT  

Extinction learning before trauma and subsequent posttraumatic stress.
Guthrie and Bryant
Psychosom. Med. 2006;68:307-311.
ABSTRACT | FULL TEXT  

Heart Rate Responsivity to Script-Driven Imagery in Posttraumatic Stress Disorder: Specificity of Response and Effects of Psychotherapy
Lindauer et al.
Psychosom. Med. 2006;68:33-40.
ABSTRACT | FULL TEXT  

Predicting Posttraumatic Stress Symptoms From Pretraumatic Risk Factors: A 2-Year Prospective Follow-Up Study in Firefighters
Heinrichs et al.
Am. J. Psychiatry 2005;162:2276-2286.
ABSTRACT | FULL TEXT  

PTSD Following Terrorist Attacks: A Prospective Evaluation
Shalev and Freedman
Am. J. Psychiatry 2005;162:1188-1191.
ABSTRACT | FULL TEXT  

Posttraumatic Stress Responses in Children: Awareness and Practice Among a Sample of Pediatric Emergency Care Providers
Ziegler et al.
Pediatrics 2005;115:1261-1267.
ABSTRACT | FULL TEXT  

Heart Rate and Posttraumatic Stress in Injured Children
Kassam-Adams et al.
Arch Gen Psychiatry 2005;62:335-340.
ABSTRACT | FULL TEXT  

Auditory Startle Response in Firefighters Before and After Trauma Exposure
Guthrie and Bryant
Am. J. Psychiatry 2005;162:283-290.
ABSTRACT | FULL TEXT  

Description of an Early Intervention to Prevent Substance Abuse and Psychopathology in Recent Rape Victims
Resnick et al.
Behav Modif 2005;29:156-188.
ABSTRACT  

Elevated Resting Heart Rate as a Predictor of Posttraumatic Stress Disorder After Severe Traumatic Brain Injury
Bryant et al.
Psychosom. Med. 2004;66:760-761.
ABSTRACT | FULL TEXT  

Posttraumatic Stress, Nonadherence, and Adverse Outcome in Survivors of a Myocardial Infarction
Shemesh et al.
Psychosom. Med. 2004;66:521-526.
ABSTRACT | FULL TEXT  

Psychiatric Morbidity Following Injury
O'Donnell et al.
Am. J. Psychiatry 2004;161:507-514.
ABSTRACT | FULL TEXT  

Surviving disaster: what comes after the trauma?
DAVIDSON
Br. J. Psychiatry 2002;181:366-368.
FULL TEXT  

REM Sleep and the Early Development of Posttraumatic Stress Disorder
Mellman et al.
Am. J. Psychiatry 2002;159:1696-1701.
ABSTRACT | FULL TEXT  

A 46-Year-Old Man With Anxiety and Nightmares After a Motor Vehicle Collision
Stein
JAMA 2002;288:1513-1521.
FULL TEXT  

Persistence of Posttraumatic Stress in Violently Injured Youth Seen in the Emergency Department
Fein et al.
Arch Pediatr Adolesc Med 2002;156:836-840.
ABSTRACT | FULL TEXT  

Post-Traumatic Stress Disorder
Yehuda
NEJM 2002;346:108-114.
FULL TEXT  

The Peritraumatic Distress Inventory: A Proposed Measure of PTSD Criterion A2
Brunet et al.
Am. J. Psychiatry 2001;158:1480-1485.
ABSTRACT | FULL TEXT  

Autonomic reactivity and psychopathology in middle childhood
BOYCE et al.
Br. J. Psychiatry 2001;179:144-150.
ABSTRACT | FULL TEXT  

Two-Year Prospective Evaluation of the Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Mild Traumatic Brain Injury
Harvey and Bryant
Am. J. Psychiatry 2000;157:626-628.
ABSTRACT | FULL TEXT  

Auditory Startle Response in Trauma Survivors With Posttraumatic Stress Disorder: A Prospective Study
Shalev et al.
Am. J. Psychiatry 2000;157:255-261.
ABSTRACT | FULL TEXT  

Treating Acute Stress Disorder: An Evaluation of Cognitive Behavior Therapy and Supportive Counseling Techniques
Bryant et al.
Am. J. Psychiatry 1999;156:1780-1786.
ABSTRACT | FULL TEXT  

Other articles noted
Evid. Based Ment. Health 1998;1:100-100.
FULL TEXT  

Is High Heart Rate in the ER a Predictor of PTSD?
JWatch Women's Health 1998;1998:14-14.
FULL TEXT