Prevalence of symptoms related to post-traumatic stress disorder during long-term follow-up in patients after surgical treatment for secondary peritonitis

Background

Symptoms related to post-traumatic stress disorder (PTSD) may occur after exposure to a traumatic event and are clustered; symptoms of re-experiencing, symptoms of avoidance, and hyperarousal symptoms. It is unknown to what extent recovered peritonitis patients experience PTSD-related symptoms. The aim of this study was to screen patients for persisting PTSD-related symptoms 4–10 years after surgical treatment for secondary peritonitis and to detect whether a difference is observed in prevalence of PTSD-related symptoms in patients with ICU admission and those without.

Methods

An existing database of 278 patients surgically treated for secondary peritonitis between 1994 and 2000 revealed that by October 2003, 131 patients were alive of which 118 patients could be tracked. A standardized validated questionnaire was mailed. PTSD-related symptoms were measured by the Post-Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10) and the Impact of Events Scale Revised questionnaire (IES-R). PTSS-10 scores > 35 or IES-R scores > 39 were regarded as fitting with PTSD-related symptoms. In addition, information regarding the presence of traumatic memories was obtained.

Results

The response rate was 88%; 101 questionnaires were suitable for analysis (86%). The mean age of the responders was 58.3 (± 14.5) years and 59% was male. The mean follow-up period after peritonitis was 7.2 (4.0–10.4) years. The mean APACHE II score on admission and Mannheim Peritonitis Index score at operation were 9.5 (± 5.2) and 22.0 (± 7.4), respectively. Sixty percent of the patients had been admitted to the ICU for a mean of 19 (± 16) days. Overall PTSS-10 scores and IES-R scores were 25.4 ± 13.6 and 28.5 ± 31.7, respectively. According to the PTSS-10 questionnaire, the overall prevalence of PTSD-related symptoms was 23%. The symptoms were observed in 28% of former ICU patients and in 15% of non-ICU patients (P = 0.21). The IES-R revealed an overall prevalence of PTSD-related symptoms in 29% of patients, 31% of former ICU patients versus 25% of non-ICU patients (P = 0.78). The concordance rate between the questionnaires was 80%. Furthermore, the presence of a traumatic memory was significantly related to the scores on the PTSS-10 (P = 0.03) and on the IES-R (P = 0.04).

Conclusion

Long-term follow-up of patients after admission for peritonitis showed a prevalence of symptoms fitting with PTSD in 23–29%. In peritonitis patients, attention should be given to early recognition of this presumably underestimated problem. Given the size and duration of the problem, research is needed into preventative measures.