Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem

Jackson, James C; Hart, Robert P; Gordon, Sharon M; Hopkins, Ramona O; Girard, Timothy D; Ely, EWesley

doi:10.1186/cc5707

Critical Care

Table 3 Studies that report the prevalence of PTSD in medical ICU patients

From: Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem

Study	Population	Design	Quality rating^a	Number lost to follow-up^b	Follow-up time point	Tool	Rate of PTSD or PTSS	Risk factors
Rattray et al., 2005 [16]	General medical ICU	Prospective cohort	2b	109 enrolled at discharge, 87 at 6 months, 80 at 12 months; 27% lost to follow-up	Hospital discharge, 6 months, and 12 months	IES	20% with high avoidance scores and 18% with high intrusion scores	Avoidance and intrusive symptoms related to younger age, 'frightening' ICU experience, APACHE II scores, ICU/hospital lengths of stay, and recall of experiences
Capuzzo et al., 2005 [9]	General medical ICU	Prospective cohort	2b	84 at 1 week, 63 at 3 months; 25% lost to follow-up	1 week and 3 months	IES	5% with PTSS	PTSD symptoms associated with fewer factual memories
Cuthbertson et al., 2004 [10]	General medical ICU	Prospective cohort	2b	111 enrolled, 78 completed; 30% lost to follow-up	3 months	DTS	14% with PTSD	PTSD associated with younger age, length of mechanical ventilation, and previous psychiatric history
Nickel et al., 2004 [11]	General medical ICU	Cross-sectional	3b	41; percentage lost to follow-up not recorded	Unknown	PTSS-10, SCID	17% with PTSS; 9.76% with PTSD	PTSD associated with previous psychiatric history
Jones et al., 2003 [12]	General medical ICU	Randomized controlled trial	1b	126 eligible patients, 114 at 8 weeks, 102 at 6 months; 20% lost to follow-up	8 weeks and 6 months	IES	51% with probable PTSD at 6-month follow-up	Presence of delusional memories increased risk of PTSD symptoms
Kress et al., 2003 [13]	General medical ICU	Prospective cohort	2b	105 patients enrolled, 32 at follow-up; 70% lost to follow-up	~1 year	IES-R, clinical interview	18.5% with PTSD; 54% from control group; 0 from intervention group	Presence of delusional memories increased the risk of PTSD; sedative interruption decreased the risk of PTSD
Schelling et al., 2001^c [1]	General medical ICU	Retrospective cohort	2b	24 eligible, 20 completed testing; 16% lost to follow-up	21 to 49 months	PTSS-10, SCID	40% with PTSD (63% placebo group; 11% treatment group)	Administration of hydrocortisone related to a lower incidence of PTSD in ICU survivors
Scragg et al., 2001 [14]	General medical ICU	Cross-sectional	3b	142 eligible, 80 usable surveys returned; 44% lost to follow-up	>5 years	IES, TSC-33, ETIC-7	30% with PTSS; 15% with PTSD	Female gender/younger age associated with increased PTSD risk
Eddleston et al., 2000 [15]	General medical ICU	Prospective cohort	2b	227 available, 143 completed; 37% lost to follow-up	3 months	Selected PTSD questions	36% with 'distressing flashbacks'	Female gender related to increased risk of distressing flashbacks
Deja et al., 2006 [23]	ARDS survivors	Retrospective cohort	2b	129 enrolled, 65 at follow-up; 50.4% lost to follow-up	57 ± 32 months	PTSS-10	29% with 'high risk' of PTSD	PTSD associated with anxiety in the ICU; perceived social support related to decreased risk of PTSD
Kapfhammer et al., 2004 [17]	ARDS survivors	Retrospective cohort	3b	80 in the original study, 46 at follow-up; 42% lost to follow up	Median of 8 years	PTSS-10, SCID	43% with PTSD at discharge; 23.9% with PTSD at follow-up	PTSD was associated with greater ICU length of stay
Shaw et al., 2001 [20]	ARDS survivors	Cross-sectional	3b	20; N/A	Unknown	IES	35% with PTSS	Unknown
Stoll et al., 1999^d [18]	ARDS survivors	Retrospective cohort	3b	52; 35% lost to follow-up	Two time points at least 2 years apart (1 to 13 years after discharge)	PTSS-10, clinical interview	25% with PTSD	Greater number of traumatic memories associated with increased frequency and intensity of PTSD
Schelling et al., 1998^d [19]	ARDS survivors	Retrospective cohort	2b	80; 22% lost to follow-up	6 to 10 years, median 4 years	PTSS-10	27.5% with PTSD	Number of adverse experiences associated with higher PTSS-10 scores
Schelling et al., 1999^c [22]	Septic shock survivors	Retrospective cohort	2b	54; percentage lost to follow-up not recorded	2 to 9 years	PTSS-10, clinical interview	38% with PTSD (18.5% with PTSD in treatment group; 59% in control group)	PTSD associated with longer ICU treatment and increased number of traumatic experiences
Nelson et al., 2000 [21]	Acute lung injury survivors	Cross-sectional	3b	34 eligible, 24 completed; 29% lost to follow-up	6 to 41 months, mean 19 months	Seven items pertaining to PTSD	39% with 'bad memories or dreams'	Deeper levels of sedation and neuromuscular blockade exposure associated with increased risk of PTSD

^aQuality of study methods was rated according to Oxford Centre for Evidence-Based Medicine guidelines and ranged from 1 to 3, with lower numbers indicating higher quality. Letters used to designate level 1 to 3 studies indicated gradations of quality ranging from 'a' (higher quality) to 'b' (lower quality). ^bTotal number of patients who were actual study participants as opposed to those who were simply enrolled; percentage lost to follow-up refers to the percentage of patients who for any reason did not participate in the follow-up portion or portions of the study. A few studies did not include follow-up components, thus loss to follow-up rates are not applicable (N/A). ^cFourteen patients in the 2001 study of Schelling et al. [1] had previously been in the 1999 investigation of Schelling et al. [22]. ^dThese investigations were conducted on the same population, and the follow-up evaluations in the 1999 study of Stoll et al. [18] occurred approximately 2 years after patients completed their participation in the 1998 study of Schelling et al. [19]. APACHE II, Acute Physiology and Chronic Health Evaluation II; ARDS, acute respiratory distress syndrome; DTS, Davidson Trauma Scale; ETIC-7, Experience of Treatment in the Intensive Care Unit-7; ICU, intensive care unit; IES, Impact of Events Scale; IES-R = Impact of Events Scale-Revised; PTSD, post-traumatic stress disorder; PTSS, post-traumatic stress symptoms; PTSS-10, Post Traumatic Stress Scale-10 for the Intensive Care Unit; SCID, Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; TSC-33, Trauma Symptom Checklist-33.

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ISSN: 1364-8535

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