Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge

Abstract

IntroductionTo study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.MethodsOf 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was ≥ 35. Case level of HADS-Anxiety or Depression was ≥ 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.ResultsMean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES ≥ 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in posttraumatic stress, anxiety or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of posttraumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.ConclusionsThe mean level of posttraumatic stress symptoms in patients one year following ICU treatment was high and one of four were above case level Predictors of posttraumatic stress symptoms were mainly demographics and experiences during hospital stay whereas clinical injury related variables were insignificant. Pessimism was a predictor of posttraumatic stress, anxiety and depression symptoms. A subgroup of patients developed clinically significant distress symptoms during the follow-up period.

Long-Term Consequences of Critical Illness: A New Opportunity For High-Impact Critical Care Nurses

“…Currently, a tremendous amount of research is being done around the world to understand the risk factors for long-term consequences of critical illness developing. Risk factors that have been identified include [2][3][4][5][6][7][8][9][10][11][12][13] • age more than 65 years • sepsis • mechanical ventilation • heavy sedation, delirium • hypoglycemia • hypoxia Reducing the risk factors may mitigate the long-term consequences that ICU patients and their families suffer. Early physical and occupational therapy started while patients are in the ICU and are hemodynamically stable can improve physical function.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13] • Encourage patients to do cycling exercises and range-of-motion activities within the first few days of admission, even those patients we once thought were appropriately left in a pharmacologically comatose state. 2,4 • Reduce the use of benzodiazepines and, instead, use other sedating agents and nonpharmacological measures to combat anxiety and discomfort imposed by critical illness.…”

“…2,4 • Reduce the use of benzodiazepines and, instead, use other sedating agents and nonpharmacological measures to combat anxiety and discomfort imposed by critical illness. [2][3][4][5][6][7][8][9][10][11][12][13] • Work hand-in-hand with therapists to move patients who are receiving mechanical ventilation, patients who had once stayed in bed and at most achieved a head-of-bed-elevated position, out of bed and onto tilt-tables or chairs. [2][3][4][5][6][7][8][9][10][11][12][13] • Help create a diary for a patient so that the patient's family can have a working document to later slowly move the patient past the delusions and misconceptions that gather in the muddled mind during critical illness.…”

A Web-Based Recovery Program (ICUTogether) for Intensive Care Survivors: Protocol for a Randomized Controlled Trial (Preprint)

“…These impairments can persist over a long period of time [4,11]. Psychological complications have been estimated to be as high as 44% of survivors at hospital discharge [1] and in some populations have been noted to increase during the year following hospital discharge [12].…”

Study protocol: Intensive care anxiety and emotional recovery (Icare)—A prospective study

“…A number of factors have been identified as predictors of these adverse emotional outcomes in ICU survivors (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In the Intensive Care Anxiety and Emotional Recovery (ICARe) study, these risk factors have been classified into three categories: prior to critical illness, during intensive care treatment and after ICU discharge risk factors (Fig.1).…”