Post-traumatic stress disorder after surgical ICU admission

Introduction

Post-traumatic stress disorder (PTSD) is a potentially serious psychiatric disorder that has traditionally been associated with traumatic stressors, such as participation in combat, having suffered violent assault, and survival after natural disasters. Recently, investigators have reported that the experience of critical illness can also lead to PTSD, although details of the association between critical illness and PTSD remain unclear. Our objective is to determine the prevalence and severity of symptoms related to the diagnosis of PTSD in a cohort of postsurgical ICU patients and to identify potential risk factors for PTSD symptoms.

Methods

A prospective cohort of patients over 18 years old, admitted to our surgical ICU for over 48 hours, between October 2002 and June 2008, were studied. Variables such as age, gender, type of admission, neoplasia, SOFA, ASA, APACHE II scores, surgical intervention, sepsis, renal failure, mechanical ventilation, cortocosteroid treatment, psychiatric history, blood product transfusions, and so forth, were recorded. The Post-Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10) was used to measure the stress symptoms a year after discharge from the unit. Five hundred and one patients met the inclusive criteria, 198 died during the follow-up year after ICU outcome. Three hundred and three patients survived, 160 of them completed the questionnaire by telephone. The association of potential risk factors with PTSS-10 scores was done by logistic regression and multivariate analysis.

Results

PTSD prevalence was 13% in our unit. Statistical analysis shows the relationship between the syndrome and the following factors: female gender, age <65 years, mechanical ventilation, daily interruption of the sedation, previous psychiatric history and blood product transfusions. The multivariate analysis shows as independent risk factors: female gender, age <65 years, previous psychiatric history and blood product transfusions.

Conclusions

Our results agree with other authors about prevalence and most of the risk factors. Nonetheless we have found a positive relationship between interruption of sedation and the development of symptoms of PTSD as with psychiatric history.