Abstract Body: Background: Cardiac Arrest (CA) studies report negative psychological outcomes (anxiety (13-61%), depression (14-45%), post-traumatic stress disorder (PTSD) (19-27%)) among survivors. In contrast, ~10% of survivors report unique positive experiences of a purposeful review of life events, a perception of lucidity with external visual awareness, and transformation with greater meaning, referred to as a recalled experience of death (RED).
Hypothesis: Undergoing a recalled experience of death during CA may protect against negative psychological outcomes, and increase positive psychological outcomes among survivors.
Methods: We established an ongoing cross-sectional study to examine psychological outcomes of CA survivors. Inclusion: CA history; age ≥ 18. We collected demographics and utilized validated scales: GAD-7 (anxiety), PHQ-9 (depression), SSS-PTSD, EQ-8 (empathy), Benefit Finding scale, Prosocial Altruistic Personality scale, SCBCS (compassion), SHS (happiness), GQ-6 (gratitude), SFI (life-satisfaction), DSES (spirituality), TFS (forgiveness), MCSDS (social desirability), LOT-R (optimism), and PTGI-SF (post-traumatic growth). RED was identified with a validated scale (near death scale) and interview confirmation. Outcomes were tested with bivariate analyses, controlled for false-discovery rate. A regression model was fitted to control for significant covariates.
Results: Among 135 CA survivors, 26 (19%) had a RED. No reported differences in anxiety or depression were found. However, PTSD was higher in those with RED vs. No-RED (65% vs. 32%; p=0.03), with 98% reporting PTSD only after CA. Among positive psychological outcomes, those with RED had higher scores in benefit finding (Mdn=65 vs. 57; p=0.03), altruism (Mdn=46 vs. 35; p=0.04), spirituality (Mdn=25 vs. 16; p=0.02), and PTGI (Mdn=37 vs. 27; p=0.02) vs. No-RED. Bivariate analyses between PTSD and positive psychological outcomes showed a difference only in PTGI (p=0.014). Even after adjusting for PTSD, those with RED demonstrated significantly greater PTGI vs. No-RED (β=6.98, SE=2.7, 95% CI [1.6, 12.4], p=0.012).
Conclusion: PTSD may occur more frequently in CA survivors who undergo a RED, however, RED is itself associated with greater positive psychological outcomes (altruism, benefit finding, spirituality, growth). Studies are needed to evaluate the mechanism underlying RED, PTSD and positive psychological outcomes and establish future clinical trials targeting improvements in psychological outcomes.