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Post-traumatic stress disorder after medical intensive care


Few studies have analyzed the prevalence of post-traumatic stress disorder (PTSD) in survivors of medical intensive care.

Patients and methods

From June 1997 to December 1999 all admissions (≥ 18 years) to our medical intensive care unit (ICU) who were treated for at least 24 hours were eligible. On admission, the pre-ICU functional status and subjective well-being were assessed by interview [1]. Six months after admission survivors' memory of the ICU stay was assessed (none, positive, negative). At 18-month follow-up a standardized interview at the patients home was performed using the PTSD-10 Questions Inventory (PTSD-10) [2], the 90-item Revised Symptom Checklist (SCL-90-R), the Hamilton Anxiety Scale and Hamilton Depression Scale, the 57-item Giessen Subjective Complaints List and a 28-item quality of life (QOL) scale.


A total of 444 patients were enrolled. Cumulative mortality rates were 23% in the ICU, 33% in the hospital, 42% at 6-month follow-up and 53% at 18-month follow-up. From the 209 survivors, 22% were lost to follow-up, 27% were unable to be interviewed due to physical or cognitive reasons and 13% declined the interview. The remaining 80 study patients had a mean age of 46 ± 12 (± SD) years; 69% were male, the mean ICU length of stay was 12 ± 17 days, the mean APACHE II score after 24 hours was 19 ± 9 and the mean SOFA total maximum score was 6.3 ± 4.7. According to PTSD-10 criteria 10 patients (12.5%) had a diagnosis of PTSD. PTSD was more frequently diagnosed in patients who had reported poor pre-ICU subjective well-being compared with patients with good subjective well-being (8/41 vs 2/39 patients; 20% vs 5%; P = 0.05), in patients with multiple organ dysfunction (MOD) compared with patients without MOD (8/38 vs 2/42 patients; 21% vs 5%; P = 0.03), and in patients who had negative or no memories of their ICU stay compared with patients with positive memories (7/30 vs 3/50 patients; 23% vs 6%; P = 0.02). Patients with PTSD had significantly (P < 0.0001) worse scores on the SCL-90-R global index of psychopathology showed a significantly (P < 0.0001) higher degree of somatic and psychic anxiety, major depression, bodily complaints and mental exhaustion, and reported poorer self-perceived QOL.


A small subgroup (12.5%) of our medical ICU survivors developed PTSD. Subjective well-being before ICU admission, MOD, and ICU memories were associated with PTSD and related psychopathologic symptomatology. These criteria could be used to identify survivors at risk for developing PTSD.


  1. Fernandez RR, et al.: Intensive Care Med 1996, 22: 1034. 10.1007/s001340050209

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  2. Stoll C, et al.: Intensive Care Med 1999, 25: 697. 10.1007/s001340050932

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Wehler, M., Stolle, M., Riek, A. et al. Post-traumatic stress disorder after medical intensive care. Crit Care 8 (Suppl 1), P343 (2004).

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