Skip to main content
Top
Published in: Intensive Care Medicine 3/2004

01-03-2004 | Original

Post-traumatic stress disorder after critical illness requiring general intensive care

Authors: Brian H. Cuthbertson, Alastair Hull, Mary Strachan, Judith Scott

Published in: Intensive Care Medicine | Issue 3/2004

Login to get access

Abstract

Objective

To determine the incidence and severity of symptoms related to the diagnosis of post-traumatic stress disorder (PTSD) in a cohort of general ICU patients.

Design

A prospective cohort study 3 months after general ICU discharge.

Setting

A general ICU in a teaching hospital in northern Scotland.

Patients and participants

Seventy-eight ICU survivors of general ICU.

Interventions

Patients were contacted 3 months after ICU discharge and asked to complete a telephone assessment of the Davidson Trauma Scale.

Measurements and results

The median score was 8, with 22% recording a score of at least 27 and 14% meeting the full diagnostic criteria for PTSD. The overall score was not correlated with sex, ICU length of stay, or APACHE II score but was inversely correlated with age and directly correlated with length of mechanical ventilation. The overall score was also related to the patient reporting having visited a GP or a mental health professional for psychological distress previous to ICU.

Conclusions

We found a high incidence of symptoms consistent with PTSD 3 months after ICU discharge in this general ICU cohort. This was associated with younger patients and those who visited their GP or a mental health professional complaining of psychological symptoms. Further research and a greater liaison between ICU staff and family practitioners and mental health practitioners is required to better identify individuals at risk and reduce psychological morbidity in this group.
Literature
1.
go back to reference Davidson JRT, Hughes D, Blazer DG, George LK (1991) Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21:713–721PubMed Davidson JRT, Hughes D, Blazer DG, George LK (1991) Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21:713–721PubMed
2.
go back to reference Kessler RC (2000) Post-traumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12 Kessler RC (2000) Post-traumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12
3.
go back to reference Alexander DA (1997) Psychological Aspects of Trauma. In: Greaves I, Porter K, Burke D (eds) Key topics in trauma. Bios, Oxford, pp 249–257 Alexander DA (1997) Psychological Aspects of Trauma. In: Greaves I, Porter K, Burke D (eds) Key topics in trauma. Bios, Oxford, pp 249–257
4.
go back to reference Hull AM, Alexander DA, Klein S (2002) A long-term follow-up study of the survivors of the Piper Alpha oil platform disaster. Br J Psychiatry 181:435–440 Hull AM, Alexander DA, Klein S (2002) A long-term follow-up study of the survivors of the Piper Alpha oil platform disaster. Br J Psychiatry 181:435–440
5.
go back to reference Helzer JE, Robins LN, McEvoy L (1987) Post-traumatic stress disorder in the general population. Findings of the epidemiological catchment area survey. N Engl J Med 17:1630–1634 Helzer JE, Robins LN, McEvoy L (1987) Post-traumatic stress disorder in the general population. Findings of the epidemiological catchment area survey. N Engl J Med 17:1630–1634
6.
go back to reference Epstein RS (1993) Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury. J Trauma Stress 6:139–145 Epstein RS (1993) Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury. J Trauma Stress 6:139–145
7.
go back to reference Shalev AY, Schreiber S, Galai T, Melmed RN (1993) Post-traumatic stress disorder following medical events. Br J Clin Psychol 32:247–253PubMed Shalev AY, Schreiber S, Galai T, Melmed RN (1993) Post-traumatic stress disorder following medical events. Br J Clin Psychol 32:247–253PubMed
8.
go back to reference Yu BH, Dimsdale JE (1999) Posttraumatic stress disorder in patients with burn injuries. J Burn Care Rehabil 20:426–433PubMed Yu BH, Dimsdale JE (1999) Posttraumatic stress disorder in patients with burn injuries. J Burn Care Rehabil 20:426–433PubMed
9.
go back to reference Ehde DM, Patterson DR, Wiechman SA, Wilson LG (2000) Post-traumatic stress symptoms and distress 1\year after burn injury. J Burn Care Rehabil 21:105–111PubMed Ehde DM, Patterson DR, Wiechman SA, Wilson LG (2000) Post-traumatic stress symptoms and distress 1\year after burn injury. J Burn Care Rehabil 21:105–111PubMed
10.
go back to reference McFarlane AC (2000) Ethnocultural issues. In: Nutt D, Davidson JRT, Zohar J (eds) Post-traumatic stress disorder. Diagnosis, management and treatment. Dunitz, London, pp187–198 McFarlane AC (2000) Ethnocultural issues. In: Nutt D, Davidson JRT, Zohar J (eds) Post-traumatic stress disorder. Diagnosis, management and treatment. Dunitz, London, pp187–198
11.
go back to reference Michaels AJ, Michaels CE, Zimmerman MA, Smith JS, Moon CH, Peterson C (1999) Posttraumatic stress disorder in injured adults: etiology by path analysis. J Trauma Injury Infect Crit Care 47:867–873 Michaels AJ, Michaels CE, Zimmerman MA, Smith JS, Moon CH, Peterson C (1999) Posttraumatic stress disorder in injured adults: etiology by path analysis. J Trauma Injury Infect Crit Care 47:867–873
12.
go back to reference Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC, McFarlane AC, Shalev AY (2000) Consensus statement on post-traumatic stress disorder from the international consensus group on depression and anxiety. J Clin Psychiatry 61S: 60–66 Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC, McFarlane AC, Shalev AY (2000) Consensus statement on post-traumatic stress disorder from the international consensus group on depression and anxiety. J Clin Psychiatry 61S: 60–66
13.
go back to reference Fauerbach JA, Lawrence JW, Munster AM, Palombo DA, Richter D (1999) Prolonged adjustment difficulties among those with acute posttrauma distress following burn injury. J Behav Med 22:359–378CrossRefPubMed Fauerbach JA, Lawrence JW, Munster AM, Palombo DA, Richter D (1999) Prolonged adjustment difficulties among those with acute posttrauma distress following burn injury. J Behav Med 22:359–378CrossRefPubMed
14.
go back to reference Fauerbach JA, Lawrence JW, Schmidt CW, Munster AM, Costa PT (2000) Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis 188:510–517PubMed Fauerbach JA, Lawrence JW, Schmidt CW, Munster AM, Costa PT (2000) Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis 188:510–517PubMed
15.
go back to reference Schnyder U, Moergeli H, Klaghofer R, Buddeberg C (2001) Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. Am J Psychiatry 158:594–599CrossRefPubMed Schnyder U, Moergeli H, Klaghofer R, Buddeberg C (2001) Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. Am J Psychiatry 158:594–599CrossRefPubMed
16.
go back to reference Shalev AY, Peri T, Canetti L, Schreiber S (1996) Predictors of PTSD in injured trauma survivors: a prospective study. Am J Psychiatry 153:219–225PubMed Shalev AY, Peri T, Canetti L, Schreiber S (1996) Predictors of PTSD in injured trauma survivors: a prospective study. Am J Psychiatry 153:219–225PubMed
17.
go back to reference Holbrook TL, Hoyt DB, Stein MB, Sieber WJ (2001) Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome. J Trauma Injury Infect Crit Care 51:287–292 Holbrook TL, Hoyt DB, Stein MB, Sieber WJ (2001) Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome. J Trauma Injury Infect Crit Care 51:287–292
18.
go back to reference Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, Rothenhausler HB, Kreuzer E, Reichart B, Peter K (2000) Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 120:505–512CrossRefPubMed Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, Rothenhausler HB, Kreuzer E, Reichart B, Peter K (2000) Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 120:505–512CrossRefPubMed
19.
go back to reference Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMed Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMed
20.
go back to reference Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14CrossRefPubMed Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14CrossRefPubMed
21.
go back to reference Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299 Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299
22.
go back to reference Ehde DM, Patterson DR, Wiechman SA, Wilson LG (1999) Post-traumatic stress symptoms and distress following acute burn injury. Burns 25:587–592CrossRefPubMed Ehde DM, Patterson DR, Wiechman SA, Wilson LG (1999) Post-traumatic stress symptoms and distress following acute burn injury. Burns 25:587–592CrossRefPubMed
23.
go back to reference Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370PubMed Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370PubMed
24.
go back to reference Marmer CR, Weiss DS (1997) The impact of event scale–revised. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford, New York, pp 399–411 Marmer CR, Weiss DS (1997) The impact of event scale–revised. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford, New York, pp 399–411
25.
go back to reference Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, Hertzberg M, Mellman T, Beckham JC, Smith RD, Davison RM, Katz R, Feldman ME (1997) Assessment of a new self-report scale for PTSD. Psychol Med 27:153–160CrossRefPubMed Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, Hertzberg M, Mellman T, Beckham JC, Smith RD, Davison RM, Katz R, Feldman ME (1997) Assessment of a new self-report scale for PTSD. Psychol Med 27:153–160CrossRefPubMed
26.
go back to reference American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington
27.
go back to reference Davidson JRT, Tharwani HM, Connor KM (2002) Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety 15:75–78CrossRefPubMed Davidson JRT, Tharwani HM, Connor KM (2002) Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety 15:75–78CrossRefPubMed
28.
go back to reference Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, & Andreski P (1998) Trauma and posttraumatic stress disorder in the community. The Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632CrossRefPubMed Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, & Andreski P (1998) Trauma and posttraumatic stress disorder in the community. The Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632CrossRefPubMed
29.
go back to reference Griffiths RD, Jones C (2002) Intensive care aftercare. Butterworth-Heineman, Oxford Griffiths RD, Jones C (2002) Intensive care aftercare. Butterworth-Heineman, Oxford
30.
go back to reference Weisaeth L (1989) Importance of high response rates in traumatic stress research. Acta Psychiatr Scand 80:131–137 Weisaeth L (1989) Importance of high response rates in traumatic stress research. Acta Psychiatr Scand 80:131–137
31.
go back to reference Klein S, Alexander DA, Hutchinson JD, Simpson JA, Simpson JM, Bell JS (2002) The Aberdeen Trauma Screening Index: an instrument to predict post-accident psychopathology. Psychol Med 32:863–871CrossRefPubMed Klein S, Alexander DA, Hutchinson JD, Simpson JA, Simpson JM, Bell JS (2002) The Aberdeen Trauma Screening Index: an instrument to predict post-accident psychopathology. Psychol Med 32:863–871CrossRefPubMed
32.
go back to reference Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Post-traumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060PubMed Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Post-traumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060PubMed
33.
go back to reference Green BL (1994) Psychosocial research in traumatic stress. J Trauma Stress 7:341–362PubMed Green BL (1994) Psychosocial research in traumatic stress. J Trauma Stress 7:341–362PubMed
34.
go back to reference Jeavons S (2000) Predicting who suffers psychological trauma in the first year after a road accident. Behav Res Ther 38:499–508CrossRefPubMed Jeavons S (2000) Predicting who suffers psychological trauma in the first year after a road accident. Behav Res Ther 38:499–508CrossRefPubMed
35.
go back to reference Schnyder U, Morgeli H, Nigg C, Klaghofer R, Renner N, Trentz O, Buddenberg C (2000) Early psychological reactions to life-threatening injuries. Crit Care Med 28:86–92PubMed Schnyder U, Morgeli H, Nigg C, Klaghofer R, Renner N, Trentz O, Buddenberg C (2000) Early psychological reactions to life-threatening injuries. Crit Care Med 28:86–92PubMed
36.
go back to reference Alexander DA (1999) Human reactions to trauma: their features and management. In: Greaves I, Porter K (eds) Pre-hospital medicine: the principles and practice of immediate care, Arnold, London Alexander DA (1999) Human reactions to trauma: their features and management. In: Greaves I, Porter K (eds) Pre-hospital medicine: the principles and practice of immediate care, Arnold, London
Metadata
Title
Post-traumatic stress disorder after critical illness requiring general intensive care
Authors
Brian H. Cuthbertson
Alastair Hull
Mary Strachan
Judith Scott
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-2004-8

Other articles of this Issue 3/2004

Intensive Care Medicine 3/2004 Go to the issue