Development of a codebook for the narrative analysis of in-hospital trauma interviews of patients following stroke

Given their sudden onset and life-threatening consequences, strokes and transient ischemic attacks (TIAs) can trigger posttraumatic stress disorder (PTSD). To gain a deeper understanding of the potential influence of factors in patients' descriptions of these medical events on PTSD, we conducted a standardized trauma interview with a convenience sample of patients hospitalized for suspected stroke/TIA (N = 98) to assess the details and emotional experience of the stroke/TIA event. Three researchers reviewed the interviews and the research literature on risk and protective factors for PTSD. From this analysis, a codebook with descriptions, examples, and scoring protocols for eight Likert scale, two categorical, and four binary codes was developed. Upon demonstrating sufficient interrater reliability, the research team scored all narratives. Three superordinate themes were identified in the analysis: distress (e.g., fear, helplessness), potential protective factors (e.g., positive expectancies, concern for loved ones), and level of detail (e.g., somatic detail, emotional detail). Differences in perceptions, themes, and expectations emerged in the narratives, indicating a wide range of responses following stroke/TIA. Additionally, patient age was negatively correlated with scores for the fear, r = -.34, p < .001, and negative consequences, r = -.24, p = .018, codes and positively associated with the likelihood of having positive expectancies, OR = 1.05, 95% CI [1.00, 1.10], p = .039. These findings provide a more comprehensive understanding of how patients reflect on their experiences post-stroke/TIA and can inform future research on the contributions of trauma narrative characteristics and emotional responses to PTSD risk.