Resuscitation 84 (2013) 873–877 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Review article Anxiety, depression, and PTSD following cardiac arrest: A systematic review of the literature  Kathryn P. Wilder Schaaf a,* , Laura K. Artman a , Mary Ann Peberdy b , William C. Walker a , Joseph P. Ornato c , Michelle R. Gossip b , Jeffrey S. Kreutzer a , For the Virginia Commonwealth University ARCTIC Investigators a Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States b Virginia Commonwealth University Advanced Resuscitation, Cooling Therapeutics, and Intensive Care (ARCTIC) Program, Richmond, VA, United States c Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States article info Article history: Received 4 October 2012 Accepted 22 November 2012 Keywords: Cardiac arrest Depression Anxiety PTSD Psychological outcomes abstract Objectives: Identify the occurrence rate of post-arrest psychological distress; evaluate methodological approaches; suggest future research priorities; address clinical implications. Methods: The electronic databases PubMed/MEDLINE and PsychInfo/APA PsycNET were utilized to search for terms including ‘Cardiac Arrest’, ‘Therapeutic Hypothermia’ and ‘Depression’, ‘Anxiety’, ‘Quality of Life’, ‘Posttraumatic Stress Disorder (PTSD)’, ‘Psychological Outcomes’, ‘Hospital Anxiety and Depression Scale (HADS)’, and ‘Beck Depression Inventory (BDI)’. Results: High rates of psychological distress have been reported after OHCA. Specifically, incidence rates of depression have ranged from 14% to 45%; anxiety rates have ranged from 13% to 61%; PTSD rates reportedly range from 19% to 27%. Variability between studies is likely attributable to methodological variations relating to measures used, time since arrest, and research setting. Discussion: Given the occurrence rate of psychological distress after OHCA, psychological screening and early intervention seems indicated in the cardiac arrest population. Further studies are needed to better establish occurrence rates in both inpatient and outpatient settings, determine appropriate measures and normative cut off scores, and decide on the most appropriate method of intervention. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Out-of-hospital sudden cardiac arrest (OHCA) affects more than 300,000 individuals in the United States each year. 1,2 Recent research and medical care innovations have successfully increased survival rates after cardiac arrest more than five-fold in some spe- cialized treatment settings. 3 With increased number of survivors, comprehensive outcomes research is needed to characterize the potential residual impairments and disabilities they face. How- ever, the vast majority of outcomes research in this population has focused on medical outcomes, with little attention given to the psychological aftermath of surviving a cardiac arrest. 4 A review of the literature on psychological well-being after car- diac arrest reveals several short-comings. First, there are relatively  A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.11.021. * Corresponding author at: Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Box 980542, Richmond, VA 23298-0542, United States. Tel.: +1 804 828 9055; fax: +1 804 828 2378. E-mail address: wilderkp@vcu.edu (K.P. Wilder Schaaf). few studies that focus primarily on psychological concerns; most address patients’ psychological condition superficially, with their primary focus on other outcomes (e.g., neurological status, cogni- tive functioning, functional status and cardiac function). 5–7 Among the few studies that focus on psychological distress, investigators have reported widely varying estimates of occurrence rates. 8–11 Second, several studies struggle to adequately distin- guish between concepts like quality of life and psychological conditions. 10,12 Although the two constructs may be correlated, they are, in fact, distinct entities. Quality of life is a broad construct which encompasses many aspects of the patient’s life, whereas, psychological conditions relate to distinct pathology as defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV TR 13 ). Quality of life can be affected by, but is quite distinct from psychological conditions such as depression, anxiety, and posttraumatic stress disorder (PTSD). Given that mental health disorders have not been well char- acterized in the cardiac arrest literature, there is a concern that psychological disorders following cardiac arrest have not received proper attention from researchers or clinicians. The high incidence and impact of concomitant psychological disease in patients who have undergone other life-changing medical events (e.g., MI and 0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2012.11.021