Skip to main content

Advertisement

Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig.1.
Fig. 2.

Similar content being viewed by others

References

  1. Davidson JRT, Hughes D, Blazer DG, George LK (1991) Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21:713–721

    CAS  PubMed  Google Scholar 

  2. Kessler RC (2000) Post-traumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12

    CAS  Google Scholar 

  3. 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. 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

    Google Scholar 

  5. 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

    Google Scholar 

  6. Epstein RS (1993) Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury. J Trauma Stress 6:139–145

    Google Scholar 

  7. Shalev AY, Schreiber S, Galai T, Melmed RN (1993) Post-traumatic stress disorder following medical events. Br J Clin Psychol 32:247–253

    PubMed  Google Scholar 

  8. Yu BH, Dimsdale JE (1999) Posttraumatic stress disorder in patients with burn injuries. J Burn Care Rehabil 20:426–433

    CAS  PubMed  Google Scholar 

  9. Ehde DM, Patterson DR, Wiechman SA, Wilson LG (2000) Post-traumatic stress symptoms and distress 1\year after burn injury. J Burn Care Rehabil 21:105–111

    CAS  PubMed  Google Scholar 

  10. 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. 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

    CAS  Google Scholar 

  12. 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

    Google Scholar 

  13. 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 22:359–378

    Article  CAS  PubMed  Google Scholar 

  14. Fauerbach JA, Lawrence JW, Schmidt CW, Munster AM, Costa PT (2000) Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis 188:510–517

    CAS  PubMed  Google Scholar 

  15. 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 158:594–599

    Article  CAS  PubMed  Google Scholar 

  16. Shalev AY, Peri T, Canetti L, Schreiber S (1996) Predictors of PTSD in injured trauma survivors: a prospective study. Am J Psychiatry 153:219–225

    CAS  PubMed  Google Scholar 

  17. 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

    CAS  Google Scholar 

  18. 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 120:505–512

    Article  CAS  PubMed  Google Scholar 

  19. 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 26:651–659

    CAS  PubMed  Google Scholar 

  20. Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14

    Article  CAS  PubMed  Google Scholar 

  21. Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299

    Google Scholar 

  22. Ehde DM, Patterson DR, Wiechman SA, Wilson LG (1999) Post-traumatic stress symptoms and distress following acute burn injury. Burns 25:587–592

    Article  CAS  PubMed  Google Scholar 

  23. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    CAS  PubMed  Google Scholar 

  24. 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. 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 27:153–160

    Article  CAS  PubMed  Google Scholar 

  26. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington

  27. 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 15:75–78

    Article  PubMed  Google Scholar 

  28. 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 55:626–632

    Article  CAS  PubMed  Google Scholar 

  29. Griffiths RD, Jones C (2002) Intensive care aftercare. Butterworth-Heineman, Oxford

  30. Weisaeth L (1989) Importance of high response rates in traumatic stress research. Acta Psychiatr Scand 80:131–137

    Google Scholar 

  31. 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 32:863–871

    Article  CAS  PubMed  Google Scholar 

  32. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Post-traumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060

    CAS  PubMed  Google Scholar 

  33. Green BL (1994) Psychosocial research in traumatic stress. J Trauma Stress 7:341–362

    CAS  PubMed  Google Scholar 

  34. Jeavons S (2000) Predicting who suffers psychological trauma in the first year after a road accident. Behav Res Ther 38:499–508

    Article  CAS  PubMed  Google Scholar 

  35. 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 28:86–92

    CAS  PubMed  Google Scholar 

  36. 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

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian H. Cuthbertson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cuthbertson, B.H., Hull, A., Strachan, M. et al. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 30, 450–455 (2004). https://doi.org/10.1007/s00134-003-2004-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-2004-8

Keywords

Navigation