The Influence of Personality Traits on Specific Coping Styles and the Development of Posttraumatic Stress Symptoms following Acute Coronary Syndrome: A Cluster Analytic Approach

Round 1

Reviewer 1 Report

The article presents an interesting and valid study on posttraumatic stress disorder, personality traits and coping strategies. All in all, I really appreciated the methodological aspects of the study and their link with the authors' hypotheses. To give thorough and (hopefully) useful feedback to the authors, I will proceed following the article structure.

First, the abstract is clear and presents in a succinct way the information about the rationale behind the study, the method and the results. There are multiple acronyms and I am not a fan of them. However, I think that their overuse is correct.

Second, the introduction is clear and presents the rationale of the study realized. I personally appreciate the way they conclude the introduction by pointing out their aim and specifying the contribution of the study.

(So far, I have many positive words for these parts)

Third, the method part is quite confusing. I do not understand how they did the data collection. Of course, they present a specific program to which they referred for the data collection. However, it is the first time that the authors mention this program, the "myocardial Infarction – Stress Prevention Intervention". I would ask the author to explain in a more narrative way how they opted for this program and why. The procedure is not clear as it is now. 

Then, please, separate the procedure and participants into two different paragraphs. The paragraph contains too much information as it is now.

The rest of the sections are okay! Especially the data analysis strategy!

Fourth, results, discussions and conclusions reflect my comments on the initial parts (abstract and introduction). The authors present the results in a clear way and they discuss them in a useful way for conducting future research studies on these themes. 

Author Response

Thank you very much for your valuable comments.

Third, the method part is quite confusing. I do not understand how they did the data collection. Of course, they present a specific program to which they referred for the data collection. However, it is the first time that the authors mention this program, the "myocardial Infarction – Stress Prevention Intervention". I would ask the author to explain in a more narrative way how they opted for this program and why. The procedure is not clear as it is now. 

Response: Thank you for this valuable comment. The data is a secondary analysis of the original MI SPRINT RCT data, where participants took part in a psychological intervention after MI.  We shortened the method part and tried to simplify the text in order to eliminate eventual confusion. Please find the new version starting from line 120-128.

“Recruitment details are described elsewhere (23). The original sample of the MI-SPRINT trial consisted of 190 MI patients, all Caucasian, 154 completed the 3-month follow-up and 104 completed the 12-month follow-up.”

Then, please, separate the procedure and participants into two different paragraphs. The paragraph contains too much information as it is now.

Response: Thank you for this comment. We separated as suggested the procedure from the participants.

Reviewer 2 Report

See my comments below to the editors.

Author Response

Thank you very much for your valuable comments. 

I found the paper too detailed. I wanted a clearer description of the clinical relevance of this work

Response: Thank you very much for this value input. We added the clinical relevance of this work at the end of the discussion (line 415-424)

“Finally, this study may have interesting practical implications for clinical practice. In clinical populations such as the target of our study (patients who have suffered an ACS), major variability may exist regarding patient characteristics, symptom severity or treatment responses and prognosis. Better understanding such heterogeneity and how some variables may appear associated with others could help developing more effective treatments and a more personalized attention to better suit patient profiles (49). By clustering patients with similar variables, it may be possible to identify which profiles may be at greater risk of developing undesirable outcomes such as PTSD after an ACS. This way, clinicians could address their interventions more specifically to those patients with greater risk earlier, hence approaching it from a preventive point of view.”    

I also wanted more detail about the post event interventions and their implications for the individuals subsequent world view.

Response: Thank you for this comment. We added the following section to the method part (line 102-111)

“Each group consisted of a face-to face single session in which patients get information for 45 minutes at bedside in the hospital within 48 hours after the ACS. Both groups consisted of a 45-minute counseling session. The intervention group (trauma-focused counseling session) and the active control group (stress counseling group) used first aid strategies, whereas the content of the psychoeducation differed. In the trauma-focused intervention group, patients were educated about PTSD symptoms particularly after an ACS and how to handle them. Information, activation of resources and cognitive r(e)structuring were discussed. In the stress counseling control group, patients were educated about stress and how stress can be dangerous and how to handle stress. At the end of the session, both groups get a information booklet with detailed information about either trauma symptoms or stress. The hypotheses behind education about PTSD symptoms was that patients would better cope with PTSS and would show lower PTSD levels in the aftermath compared to the active control group.”