This study had several limitations. The antecedent psychiatric risk
factors detected in this study (neuroticism and past experience of trauma)
may be attributable to the selection and recall biases. For example,
the healthy volunteers were a cohort of older adults recruited during a
time of frequent ongoing aftershocks in the region, with widespread
community concerns regarding the safety of remaining buildings. The
volunteers were required to attend a clinic in a multistory building to
complete the assessment; this may have biased selection of volunteers
towards individuals with low neuroticism.
This study also raises questions regarding the proposed link between
acute stress and development of earthquake related stress cardiomyopathy.
Despite all groups reporting similar experiences during the earthquakes
it remains uncertain why only a minority of the population
exposed to this event developed SCM. Our findings suggest that the
clinical assessment of psychiatric risk factors is unlikely to assist identification
of patients at increased risk of stress cardiomyopathy.