Predictors of post-traumatic stress disorder following critical illness: A mixed methods study

Battle, Ceri; James, Karen; Bromfield, Tom; Temblett, P

doi:10.1177/1751143717713853

Cited by 17 publications

(11 citation statements)

References 26 publications

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“…Most importantly, because benzodiazepines have more prolonged effects in women, owing to their lipophilic nature, it is worth‐exploring in the future whether sedation practices may in part account for the sex differences observed in post‐ICU PTSD rates 26 . Although previous findings point to younger age as a potential risk factor of post‐ICU PTSD symptoms, our results did not support this 18,21,24 …”

Section: Discussioncontrasting

confidence: 80%

“…Specifically, regardless of other clinical and demographic characteristics, MVD was the most significant predictor of PTSD symptoms manifestation. Battle et al, 24 on the other hand, identified lower APACHE II score, pre‐illness psychopathology, and delirium during ICU stay as significant predictors of PTSD symptoms; whereas length of ICU stay and of mechanical ventilation have not been consistent predictors across studies 18 …”

Section: Discussionmentioning

confidence: 99%

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Pilot exploration of post‐traumatic stress symptoms in intensive care unit survivors in Cyprus

Karanikola

Alexandrou²,

Mpouzika

et al. 2020

Nursing in Critical Care

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Background Approximately, 20% of intensive care unit (ICU) survivors develop post‐traumatic stress disorder (PTSD) symptoms. Although Davidson Trauma Scale (DTS) provides a comprehensive approach to PSTD symptoms, there is no evidence on DTS‐I‐M use in ICU survivors. Aims and objectives To validate the modified intensity Davidson Trauma Scale (DTS‐I‐M) (wherein the frequency and severity subscales are combined to express symptoms intensity) in a convenience sample of ICU survivors in Cyprus, and to explore the prevalence of PTSD symptoms and related predictors. Design An instrument validation design, along with a cross‐sectional, correlational study design was employed. Methods Translation and cultural adaptation of the instrument were achieved through a group of experts and pilot testing. The DTS‐I‐M was administered via telephone. Participants' clinical data (length of ICU stay [LOS], mechanical ventilation duration [MVD], admission diagnosis, medication history) and demographics (age, gender) were collected. Non‐parametric comparisons, and regression analyses to identify predictors of DTS‐I‐M scores and PTSD symptoms were employed. Results The Cypriot DTS‐I‐M version demonstrated high test‐retest (Pearson's r = 0.928, P < .001) and internal consistency (Cronbach's [α] alpha = .97) reliability in a sample of 69 ICU survivors (62.7% response). About 36.2% of participants reported PTSD symptoms. Factor analysis confirmed the construct validity of the DTS‐I‐M, and a 3‐factor structure (encompassing intrusive, avoidance, hyperarousal, mood, and cognitive symptoms). In a multiple regression, MVD (B = −3.11, OR [95% CI] = 22.58 [3.07‐166.09, P = .002]) and LOS (r2 = 0.302, P = .002) were statistically significant predictors of DTS‐I‐M score. Conclusion We confirm the applicability of the DTS‐I‐M for the assessment of PTSD symptoms in ICU survivors; and offer preliminary evidence on the prevalence and predictors of post‐ICU PTSD symptoms in Cyprus. Relevance to clinical practice DTS‐I‐M is an appropriate screening tool for PTSD symptoms after ICU hospitalization. Patients with longer MVD and LOS are at higher risk for post‐ICU PTSD symptoms and seem to experience more intense relevant symptoms.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Pilot exploration of post‐traumatic stress symptoms in intensive care unit survivors in Cyprus

Karanikola

Alexandrou²,

Mpouzika

et al. 2020

Nursing in Critical Care

View full text Add to dashboard Cite

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“…It is well known that various factors influence mental health outcomes following a traumatic incidence. Besides the type and intensity of trauma (ICU related factors), factors like sociocultural affect, post-trauma support, coping strategies and psychosocial support available also contribute to the development of posttraumatic stress [4][5][6]. Besides health-related concerns, admission to the ICU may have worries regarding the risk of death, post ICU disabilities, and functioning.…”

Section: Introductionmentioning

confidence: 99%

Post traumatic stress symptoms, anxiety, and depression in patients after intensive care unit discharge – a longitudinal cohort study from a LMIC tertiary care centre

et al. 2020

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Background: Data on intensive care unit (ICU) related psychiatric morbidity from Low Middle-Income Countries are sparse. We studied the ICU related posttraumatic stress symptoms (PTSS), anxiety, and depression symptoms in a cohort of patients from Eastern India. Methods: We included adults admitted more than 24 h to a mixed ICU. PTSS, anxiety, and depression symptoms were assessed by telephonic or face to face interviews by using the Impact of Events-r (IES-r) and Hospital anxiety and depression (HADS), respectively, at 0, 7,14, 30, 90 and 180 days from ICU discharge. The loss to follow up was minimal. Demographic, socioeconomic, quality of life (QOL), and critical care related variables were studied. Results: Of 527 patients, 322 (59.4%) completed 6 months' follow up. The majority were male (60%), mechanically ventilated > 48 h (59.4%), mean age of 48 (+/− 16), mean acute physiology and chronic health evaluation II (APACHE II) at admission 9.4 (+/− 4.6), median length of stay 3 (2-28 days). The rates of ICU related clinical PTSS was < 1 and < 3% for anxiety/depression at any point of follow up. Data were analyzed by linear mixed (random effects) models. There was a significant drop in all scores and association with repeated measures over time. Poor QOL at discharge from the ICU showed significant association with PTSS, anxiety, and depression (β = − 2.94, − 1.34, − 0.7 respectively) when corrected for gender and education levels. Younger age, greater severity of illness, and prior stressful life experiences predicted worse PTSS (β = − 0.02, 0.08, 3.82, respectively). Benzodiazepines and lower sedation scores (better alertness) predicted lower depression symptoms. (β = − 0.43, 0.37 respectively). Conclusion: ICU related psychiatric morbidity rates in our population are low compared with reported rates in the literature. Poor QOL at ICU discharge may predict worse long-term mental health outcomes. Further research on the impact of ICU and sociocultural factors on mental health outcomes in patients from different backgrounds is needed. The study was registered at CTRI/2017/07/008959.

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“…However, the increasing number of sepsis survivors has created a growing need to address the downstream challenges after sepsis (5,6). After experiencing an episode of sepsis, as many as 75% of patients develop new functional disabilities and 34% develop severe cognitive impairment (7)(8)(9)(10)(11)(12)(13)(14).…”

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confidence: 99%

Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis

Taylor¹,

Chou

Sierra³

et al. 2020

Annals ATS

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Rationale: Postsepsis care recommendations target specific deficits experienced by sepsis survivors in elements such as optimization of medications, screening for functional impairments, monitoring for common and preventable causes of health deterioration, and consideration of palliative care. However, few data are available regarding the application of these elements in clinical practice.Objectives: To quantify the delivery of postsepsis care for patients discharged after hospital admission for sepsis and evaluate the association between receipt of postsepsis care elements and reduced mortality and hospital readmission within 90 days.Methods: We conducted a retrospective chart review of a random sample of patients who were discharged alive after an admission for sepsis (identified from International Classification of Diseases, 10th Revision discharge codes) at 10 hospitals during 2017. We used a structured chart abstraction to determine whether four elements of postsepsis care were provided within 90 days of hospital discharge, per expert recommendations. We used multivariable logistic regression to evaluate the association between receipt of care elements and 90-day hospital readmission and mortality, adjusted for age, comorbidity, length of stay, and discharge disposition.Results: Among 189 sepsis survivors, 117 (62%) had medications optimized, 123 (65%) had screening for functional or mental health impairments, 86 (46%) were monitored for common and preventable causes of health deterioration, and 110 (58%) had care alignment processes documented (i.e., assessed for palliative care or goals of care). Only 20 (11%) received all four care elements within 90 days. Within 90 days of discharge, 66 (35%) patients were readmitted and 33 (17%) died (total patients readmitted or died, n = 82). Receipt of two (odds ratio [OR], 0.26; 95% confidence interval [95% CI], 0.10-0.69) or more (three OR, 0.28; 95% CI, 0.11-0.72; four OR, 0.12; 95% CI, 0.03-0.50) care elements was associated with lower odds of 90-day readmission or 90-day mortality compared with zero or one element documented. Optimization of medications (no medication errors vs. one or more errors; OR, 0.44; 95% CI, 0.21-0.92), documented functional or mental health assessments (physical function plus swallowing/mental health assessments vs. no assessments; OR, 0.14; 95% CI, 0.05-0.40), and documented goals of care or palliative care screening (OR, 0.52; 95% CI, 0.25-1.05; not statistically significant) were associated with lower odds of 90-day readmission or 90-day mortality. Conclusions:In this retrospective cohort study of data from a single health system, we found variable delivery of recommended postsepsis care elements that were associated with reduced morbidity and mortality after hospitalization for sepsis. Implementation strategies to efficiently overcome barriers to adopting recommended postsepsis care may help improve outcomes for sepsis survivors.

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Predictors of post-traumatic stress disorder following critical illness: A mixed methods study

Cited by 17 publications

References 26 publications

Pilot exploration of post‐traumatic stress symptoms in intensive care unit survivors in Cyprus

Pilot exploration of post‐traumatic stress symptoms in intensive care unit survivors in Cyprus

Post traumatic stress symptoms, anxiety, and depression in patients after intensive care unit discharge – a longitudinal cohort study from a LMIC tertiary care centre

Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis

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