Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses.

Abstract

The intensive care unit (ICU) has been portrayed as psychologically stressful, with a growing body of research substantiating elevated rates of depression, posttraumatic stress disorder (PTSD), and other psychological disruptions in populations of critical care survivors. To explain these psychopathology elevations, some have proposed a direct effect of ICU admission upon the later development of psychopathology, whereas others highlight the complex interaction between the trauma of a life-threatening illness or injury and the stressful life-saving interventions often administered in the ICU. However, the conclusion that the ICU is an independent causal factor in trauma-related psychological outcomes may be premature. Current ICU research suffers from important methodological problems including lack of true prospective data, failure to employ appropriate comparison groups, sampling bias, measurement issues, and problems with statistical methodology. In addition, the ICU literature has yet to investigate important risk and resilience factors that have been empirically validated in the broader stress-response literature. The authors propose the application of these important constructs to the unique setting of the ICU. This review focuses on multiple aspects of the important but complex research question of whether the ICU confers risk for psychological distress above and beyond the traumatic impact of the serious health events that necessitate ICU treatment. (PsycINFO Database Record

Intensive Care Unit Delirium and Intensive Care Unit–Related Posttraumatic Stress Disorder

“…One study found that social support was significantly negatively associated with PTSD symptoms in a sample of ICU patients admitted for ARDS. This association in ICU-treated individuals between social support and decreased psychological distress could represent an important topic for future research (87, 93). …”

“…Similarly, Cuthbertson et al found that treatment-seeking behaviors for psychological distress prior to ICU predicted eventual development of PTSD (86). However these studies assessed previous psychiatric history using retrospective accounts, and it could be questioned if the self-reports of previous psychopathology may have been increased by current psychological distress (87). …”

“…In general, broader personality traits have been associated with greater resilience to PTSD, including extraversion and conscientiousness, whereas neuroticism and negative emotionality have been positively associated with PTSD development (87). Social support may play an important protective role against the development of PTSD (110).…”

“…Rehabilitation Psychology, Vol 61(2), May 2016, 120–131. http://dx.doi.org/10.1037/rep0000073, American Psychological Association, (87). …”

“Never in my mind to give up!” A qualitative study of long‐term intensive care patients’ inner strength and willpower—Promoting and challenging aspects

“…The medical conditions of long-term ICU patients often fluctuate due to complications such as infections and re-intubation. ICU stays beyond 7 days are associated with a high mortality rate (Carden et al, 2008;Moitra et al, 2016) and elevated rates of psychopathology (Kean et al, 2017;McGiffin, Galatzer-Levy, & Bonanno, 2016). In spite of multiple challenges from long-term, life-threatening illnesses, along with medical treatment and nursing interventions, some long-term ICU patients demonstrate an exceptional inner strength (Smith, Dingley, & Roux, 2018) and will to go on living (Alpers, Helseth, & Bergbom, 2012;Engstrøm, Nystrøm, Sundelin, & Rattray, 2013).…”