Psychological stress in postural tachycardia syndrome: results of an online survey

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Postural orthostatic tachycardia syndrome (POTS) is a chronic condition in which patients show a marked increase in heart rate on standing, but also suffer from a range of additional symptoms, which may include fatigue and unrefreshing sleep. A well accepted 10-item survey instrument, the Perceived Stress Scale (PSS; Cohen, et al., 1983), was used to investigate the levels of psychological stress experienced by POTS patients. METHODS: Sixty Swedish patients diagnosed with POTS at a tertiary investigation center were contacted by mail and a link was provided to respondents who signed the informed consent form. A 64-item, on-line survey was developed in five sections. One of the sections consisted of the ten items of the PSS scale. As an example, item three asks: "In the last month, how often have you felt nervous and ‘stressed’?". A five-point Likert scale is used with possible responses ranging from "never" to "very often". This study employed a previously translated Swedish language version, which has been validated in a sample of 3,406 respondents and showed good internal reliability (α =.84) and normative data for a Swedish population (Nordin & Nordin, 2013). Symptoms were measured using the orthostatic hypotension questionnaire (Kaufmann et al. 2012). RESULTS: Twenty-four POTS patients (22 female gender; mean age 35 years, SD = 8.4) completed the survey. The average age at onset of symptoms was 20 years and four months with patients waiting an average of nine years and five months for a POTS diagnosis. Scores for the PSS ranged from three to 35. The mean PSS score for this cohort was 19.38 (SD = 8.88). Fourteen respondents were in the moderate range for perceived stress (14 to 26), whilst five can be considered to have a low perception of stress and five a high perception. Patients with POTS had a statistically significant higher score for perceived stress (M = 19.38, SD = 8.88, p < .01) than the general population of Sweden (M = 13.96, SD = 5.63). However, there was no correlation between perceptions of stress and symptom severity measured by the orthostatic hypotension questionnaire. CONCLUSIONS: Swedish POTS patients have higher levels of perceived stress, similar to other disease states such as chronic pain and multiple sclerosis (Table 1). However, this survey found no correlation between perceptions of stress and symptom severity. [Figure: see text]