Health Insurance, Perceived Threat, and Posttraumatic Stress After Suspected Acute Coronary Syndrome

Margaret E. Murdock, Gaspar J. Cruz, Lilly Derby, Julia Ellis, Ian M. Kronish, Donald Edmondson, Jeffrey L. Birk

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. Method: Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the out=come, and ED threat perceptions as the mediator, with the same covariates. Results: Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as “Other” race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = −0.16, 95% CI [−0.26, −0.06], p =.002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = −1.04, 95% CI [−1.98, −0.17]. Conclusions: Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS.

Original languageEnglish
Pages (from-to)34-40
Number of pages7
JournalHealth Psychology
Volume43
Issue number1
DOIs
StatePublished - 2024
Externally publishedYes

Keywords

  • acute coronary syndrome
  • emergency department
  • health insurance
  • posttraumatic stress symptoms
  • threat perceptions

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