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Published in: Critical Care 1/2007

Open Access 01-02-2007 | Research

Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis

Authors: Kimberly R Boer, Cecilia W Mahler, Cagdas Unlu, Bas Lamme, Margreeth B Vroom, Mirjam A Sprangers, Dirk J Gouma, Johannes B Reitsma, Corianne A De Borgie, Marja A Boermeester

Published in: Critical Care | Issue 1/2007

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Abstract

Introduction

The aim of this study was to determine the long-term prevalence of post-traumatic stress disorder (PTSD) symptomology in patients following secondary peritonitis and to determine whether the prevalence of PTSD-related symptoms differed between patients admitted to the intensive care unit (ICU) and patients admitted only to the surgical ward.

Method

A retrospective cohort of consecutive patients treated for secondary peritonitis was sent a postal survey containing a self-report questionnaire, namely the Post-traumatic Stress Syndrome 10-question inventory (PTSS-10). From a database of 278 patients undergoing surgery for secondary peritonitis between 1994 and 2000, 131 patients were long-term survivors (follow-up period at least four years) and were eligible for inclusion in our study, conducted at a tertiary referral hospital in Amsterdam, The Netherlands.

Results

The response rate was 86%, yielding a cohort of 100 patients; 61% of these patients had been admitted to the ICU. PTSD-related symptoms were found in 24% (95% confidence interval 17% to 33%) of patients when a PTSS-10 score of 35 was chosen as the cutoff, whereas the prevalence of PTSD symptomology when borderline patients scoring 27 points or more were included was 38% (95% confidence interval 29% to 48%). In a multivariate analyses controlling for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of relaparotomies and length of hospital stay, the likelihood of ICU-admitted patients having PTSD symptomology was 4.3 times higher (95% confidence interval 1.11 to 16.5) than patients not admitted to the ICU, using a PTSS-10 score cutoff of 35 or greater. Older patients and males were less likely to report PTSD symptoms.

Conclusion

Nearly a quarter of patients receiving surgical treatment for secondary peritonitis developed PTSD symptoms. Patients admitted to the ICU were at significantly greater risk for having PTSD symptoms after adjusting for baseline differences, in particular age.
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Literature
1.
go back to reference Lamme B, Boermeester MA, Belt EJ, van Till JW, Gouma DJ, Obertop H: Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis. Br J Surg 2004, 91: 1046-1054. 10.1002/bjs.4517CrossRefPubMed Lamme B, Boermeester MA, Belt EJ, van Till JW, Gouma DJ, Obertop H: Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis. Br J Surg 2004, 91: 1046-1054. 10.1002/bjs.4517CrossRefPubMed
2.
go back to reference Haraldsen P, Andersson R: Quality of life, morbidity, and mortality after surgical intensive care: a follow-up study of patients treated for abdominal sepsis in the surgical intensive care unit. Eur J Surg Suppl 2003, 588: 23-27.PubMed Haraldsen P, Andersson R: Quality of life, morbidity, and mortality after surgical intensive care: a follow-up study of patients treated for abdominal sepsis in the surgical intensive care unit. Eur J Surg Suppl 2003, 588: 23-27.PubMed
3.
go back to reference Capuzzo M, Valpondi V, Cingolani E, Gianstefani G, De Luca S, Grassi L, Alvisi R: Post-traumatic stress disorder-related symptoms after intensive care. Minerva Anestesiol 2005, 71: 167-179.PubMed Capuzzo M, Valpondi V, Cingolani E, Gianstefani G, De Luca S, Grassi L, Alvisi R: Post-traumatic stress disorder-related symptoms after intensive care. Minerva Anestesiol 2005, 71: 167-179.PubMed
4.
go back to reference Cuthbertson BH, Hull A, Strachan M, Scott J: Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004, 30: 450-455. 10.1007/s00134-003-2004-8CrossRefPubMed Cuthbertson BH, Hull A, Strachan M, Scott J: Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004, 30: 450-455. 10.1007/s00134-003-2004-8CrossRefPubMed
5.
go back to reference Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W, Loew T: The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med 2004, 19: 285-290. 10.1177/0885066604267684CrossRefPubMed Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W, Loew T: The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med 2004, 19: 285-290. 10.1177/0885066604267684CrossRefPubMed
6.
go back to reference Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, et al.: Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 1998, 26: 651-659. 10.1097/00003246-199804000-00011CrossRefPubMed Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, et al.: Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 1998, 26: 651-659. 10.1097/00003246-199804000-00011CrossRefPubMed
7.
go back to reference Schelling G, Richter M, Roozendaal B, Rothenhausler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M, Kapfhammer HP: Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med 2003, 31: 1971-1980. 10.1097/01.CCM.0000069512.10544.40CrossRefPubMed Schelling G, Richter M, Roozendaal B, Rothenhausler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M, Kapfhammer HP: Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med 2003, 31: 1971-1980. 10.1097/01.CCM.0000069512.10544.40CrossRefPubMed
8.
go back to reference Scragg P, Jones A, Fauvel N: Psychological problems following ICU treatment. Anaesthesia 2001, 56: 9-14. 10.1046/j.1365-2044.2001.01714.xCrossRefPubMed Scragg P, Jones A, Fauvel N: Psychological problems following ICU treatment. Anaesthesia 2001, 56: 9-14. 10.1046/j.1365-2044.2001.01714.xCrossRefPubMed
9.
go back to reference American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Post-traumatic Stress Disorder Syndrome. Washington DC: Harcourt Assessment BV; 1994. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Post-traumatic Stress Disorder Syndrome. Washington DC: Harcourt Assessment BV; 1994.
10.
go back to reference Deja M, Denke C, Weber-Carstens S, Schroeder J, Pille CE, Hokema F, Falke KJ, Kaisers U: Social support during intensive care unit stay might reduce the risk for the development of posttraumatic stress disorder and consequently improve health related quality of life in survivors of acute respiratory distress syndrome. Crit Care 2006, 10: R147. 10.1186/cc5070PubMedCentralCrossRefPubMed Deja M, Denke C, Weber-Carstens S, Schroeder J, Pille CE, Hokema F, Falke KJ, Kaisers U: Social support during intensive care unit stay might reduce the risk for the development of posttraumatic stress disorder and consequently improve health related quality of life in survivors of acute respiratory distress syndrome. Crit Care 2006, 10: R147. 10.1186/cc5070PubMedCentralCrossRefPubMed
11.
go back to reference Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G: Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 2004, 161: 45-52. 10.1176/appi.ajp.161.1.45CrossRefPubMed Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G: Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 2004, 161: 45-52. 10.1176/appi.ajp.161.1.45CrossRefPubMed
12.
go back to reference Schelling G, Stoll C, Kapfhammer HP, Rothenhausler HB, Krauseneck T, Durst K, Haller M, Briegel J: The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med 1999, 27: 2678-2683. 10.1097/00003246-199912000-00012CrossRefPubMed Schelling G, Stoll C, Kapfhammer HP, Rothenhausler HB, Krauseneck T, Durst K, Haller M, Briegel J: The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med 1999, 27: 2678-2683. 10.1097/00003246-199912000-00012CrossRefPubMed
13.
go back to reference Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 38-46.PubMed Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 38-46.PubMed
14.
go back to reference Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, et al.: Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies. Intensive Care Med 2005, 31: 356-372. 10.1007/s00134-005-2573-9CrossRefPubMed Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, et al.: Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies. Intensive Care Med 2005, 31: 356-372. 10.1007/s00134-005-2573-9CrossRefPubMed
15.
go back to reference Weisaeth L: The stressors and the post-traumatic stress syndrome after an industrial disaster. Acta Psychiatr Scand Suppl 1989, 355: 25-37.CrossRefPubMed Weisaeth L: The stressors and the post-traumatic stress syndrome after an industrial disaster. Acta Psychiatr Scand Suppl 1989, 355: 25-37.CrossRefPubMed
16.
go back to reference Weisaeth L: Torture of a Norwegian ship's crew. The torture, stress reactions and psychiatric after-effects. Acta Psychiatr Scand Suppl 1989, 355: 63-72.CrossRefPubMed Weisaeth L: Torture of a Norwegian ship's crew. The torture, stress reactions and psychiatric after-effects. Acta Psychiatr Scand Suppl 1989, 355: 63-72.CrossRefPubMed
17.
go back to reference Stoll C, Kapfhammer HP, Rothenhausler HB, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G: Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 1999, 25: 697-704. 10.1007/s001340050932CrossRefPubMed Stoll C, Kapfhammer HP, Rothenhausler HB, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G: Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 1999, 25: 697-704. 10.1007/s001340050932CrossRefPubMed
18.
go back to reference Horowitz MJ, Wilner N, Kaltreider N, Alvarez W: Signs and symptoms of posttraumatic stress disorder. Arch Gen Psychiatry 1980, 37: 85-92.CrossRefPubMed Horowitz MJ, Wilner N, Kaltreider N, Alvarez W: Signs and symptoms of posttraumatic stress disorder. Arch Gen Psychiatry 1980, 37: 85-92.CrossRefPubMed
19.
go back to reference Stein MB, Walker JR, Hazen AL, Forde DR: Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 1997, 154: 1114-1119.CrossRefPubMed Stein MB, Walker JR, Hazen AL, Forde DR: Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 1997, 154: 1114-1119.CrossRefPubMed
20.
go back to reference Brown L, Cai TT, DasGupta A: Interval estimation for binomial proportion. Stat Sci 2001, 16: 101-133. Brown L, Cai TT, DasGupta A: Interval estimation for binomial proportion. Stat Sci 2001, 16: 101-133.
21.
go back to reference Rattray JE, Johnston M, Wildsmith JA: Predictors of emotional outcomes of intensive care. Anaesthesia 2005, 60: 1085-1092. 10.1111/j.1365-2044.2005.04336.xCrossRefPubMed Rattray JE, Johnston M, Wildsmith JA: Predictors of emotional outcomes of intensive care. Anaesthesia 2005, 60: 1085-1092. 10.1111/j.1365-2044.2005.04336.xCrossRefPubMed
22.
go back to reference van der Ploeg E, Mooren TT, Kleber RJ, van der Velden PG, Brom D: Construct validation of the Dutch version of the impact of event scale. Psychol Assess 2004, 16: 16-26. 10.1037/1040-3590.16.1.16CrossRefPubMed van der Ploeg E, Mooren TT, Kleber RJ, van der Velden PG, Brom D: Construct validation of the Dutch version of the impact of event scale. Psychol Assess 2004, 16: 16-26. 10.1037/1040-3590.16.1.16CrossRefPubMed
23.
go back to reference Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J, Dagge A, Rothenhausler HB, Krauseneck T, Nollert G, Kapfhammer HP: Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 2004, 55: 627-633. 10.1016/j.biopsych.2003.09.014CrossRefPubMed Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J, Dagge A, Rothenhausler HB, Krauseneck T, Nollert G, Kapfhammer HP: Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 2004, 55: 627-633. 10.1016/j.biopsych.2003.09.014CrossRefPubMed
24.
go back to reference Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC: Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 2005, 35: 317-327. 10.1017/S0033291704003514PubMedCentralCrossRefPubMed Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC: Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 2005, 35: 317-327. 10.1017/S0033291704003514PubMedCentralCrossRefPubMed
25.
go back to reference Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 28-37.PubMed Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 28-37.PubMed
26.
go back to reference Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 21-27.PubMed Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 21-27.PubMed
27.
go back to reference Perkonigg A, Kessler RC, Storz S, Wittchen HU: Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 2000, 101: 46-59. 10.1034/j.1600-0447.2000.101001046.xCrossRefPubMed Perkonigg A, Kessler RC, Storz S, Wittchen HU: Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 2000, 101: 46-59. 10.1034/j.1600-0447.2000.101001046.xCrossRefPubMed
28.
go back to reference Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 47-54.PubMed Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al.: Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420: 47-54.PubMed
29.
go back to reference Liberzon I, Abelson JL, Amdur RL, King AP, Cardneau JD, Henke P, Graham LM: Increased psychiatric morbidity after abdominal aortic surgery: risk factors for stress-related disorders. J Vasc Surg 2006, 43: 929-934. 10.1016/j.jvs.2006.01.026CrossRefPubMed Liberzon I, Abelson JL, Amdur RL, King AP, Cardneau JD, Henke P, Graham LM: Increased psychiatric morbidity after abdominal aortic surgery: risk factors for stress-related disorders. J Vasc Surg 2006, 43: 929-934. 10.1016/j.jvs.2006.01.026CrossRefPubMed
30.
go back to reference Stoll C, Haller M, Briegel J, Meier M, Manert W, Hummel T, Heyduck M, Lenhart A, Polasek J, Bullinger M, et al.: Health-related quality of life. Long-term survival in patients with ARDS following extracorporeal membrane oxygenation (ECMO) [in German]. Anaesthesist 1998, 47: 24-29. 10.1007/s001010050518CrossRefPubMed Stoll C, Haller M, Briegel J, Meier M, Manert W, Hummel T, Heyduck M, Lenhart A, Polasek J, Bullinger M, et al.: Health-related quality of life. Long-term survival in patients with ARDS following extracorporeal membrane oxygenation (ECMO) [in German]. Anaesthesist 1998, 47: 24-29. 10.1007/s001010050518CrossRefPubMed
31.
go back to reference Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J: Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004, 140: 189-202.CrossRefPubMed Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J: Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004, 140: 189-202.CrossRefPubMed
Metadata
Title
Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis
Authors
Kimberly R Boer
Cecilia W Mahler
Cagdas Unlu
Bas Lamme
Margreeth B Vroom
Mirjam A Sprangers
Dirk J Gouma
Johannes B Reitsma
Corianne A De Borgie
Marja A Boermeester
Publication date
01-02-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5710

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