Post-traumatic stress disorder after medical intensive care

Introduction

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.

Results

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.

Conclusion

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.