Posttraumatic Stress Disorder Following Critical Illness
Section snippets
Survivors of critical illness
The bulk of the literature investigating PTSD after critical illness has examined survivors of critical illness. Two systematic reviews of the topic recently have been published; the first looked at PTSD in 16 studies of medical ICU patients [2] and the second looked at survivors of all intensive care treatment [6]. For this review, only studies that evaluated the association between medical ICU admission and PTSD (or posttraumatic stress symptoms) are included, similar to the review by Jackson
Family members of survivors of critical illness
Far fewer studies have investigated the prevalence of PTSD in family members of individuals who survive their critical illness and these studies are outlined in Table 2[5], [24]. The largest of these was conducted in France by Azoulay and colleagues [5] and was a longitudinal study conducted in 21 medical-surgical ICUs in 2003. Family members were eligible for study if they came to an ICU to visit a patient who had an ICU stay of greater than 48 hours. The closest family member was identified
Family members of those who die after critical illness
There are several studies that have looked at PTSD after bereavement not specific to ICUs. In one such study, widows and widowers were interviewed with the SCID 2 months after death of a spouse and the investigators found that 10% of widows and widowers met criteria for PTSD at that time [26]. They found no significant difference between types of death, when comparing deaths from chronic illness versus sudden, unexpected death. They did not discuss hospitalization or ICU admissions, however,
Limitations of current research
There are several challenges to studying PTSD in general and particularly in this population after critical illness. The diagnosis of PTSD requires not only symptoms of distress but also a precipitating traumatic event. There is significant comorbidity with PTSD and other psychiatric illnesses [1]. As such, it often is difficult to decipher the cause of PTSD symptoms and the relative contribution of PTSD to an individual's overall level of distress. In studies in ICUs in particular, the
Relevance to critical care clinicians
It is important that critical care clinicians be aware that PTSD is a potential morbidity of critical illness for patients who survive their illness and for family members of those who survive or die after their critical illness. Although the diagnosis of PTSD can be made only after the incident of critical illness and, therefore, is beyond the scope of practice for most critical care clinicians, it may be important to be aware of potential risk factors for this morbidity during the course of
Summary
Despite the limitations (described previously), there is consistent evidence in the literature that the prevalence of PTSD in survivors of critical care is elevated above that seen in the general population. Similarly, prevalence for family members of survivors and those who died during their ICU stay are elevated. The experience of an ICU, for patients and their families, has the potential to cause significant psychologic distress. PTSD is an important sequela of critical illness and should be
References (30)
- et al.
The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors
Biol Psychiatry
(2001) - et al.
Linguistic analysis to assess medically related posttraumatic stress symptoms
Psychosomatics
(2001) - et al.
Shortterm psychologic impact on family members of intensive care unit patients
J Psychosom Res
(2006) - et al.
Family member satisfaction with end-of-life decision making in the ICU
Chest
(2008) Post-traumatic stress disorder
N Engl J Med
(2002)- et al.
Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem
Crit Care
(2007) Diagnostic and statistical manual of mental disorders, 4th edition: DSM-IV
(1994)- et al.
Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study
Crit Care
(2007) - et al.
Risk of post-traumatic stress symptoms in family members of intensive care unit patients
Am J Respir Crit Care Med
(2005) - et al.
The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review
Intensive Care Med
(2007)
Post-traumatic stress disorder-related symptoms after intensive care
Minerva Anestesiol
Post-traumatic stress disorder after critical illness requiring general intensive care
Intensive Care Med
The long-term psychological effects of daily sedative interruption on critically ill patients
Am J Respir Crit Care Med
Survival, morbidity, and quality of life after discharge from intensive care
Crit Care Med
Predictors of emotional outcomes of intensive care
Anaesthesia
Cited by (18)
Moving beyond survival as a measure of success: Understanding the patient experience of necrotizing soft-tissue infections
2014, Journal of Surgical ResearchCitation Excerpt :This allowed us to explore the potential ramifications for partners and family members and to identify evidence of posttraumatic stress in the survivors' partners. Although prior research has studied the incidence of posttraumatic stress in survivors of critical illness and found it to be quite common, very few have explored this phenomenon among family members [19]. Our patient interviews stress the importance the patients themselves place on this aspect of recovery, and highlights the need to determine the incidence and severity of family and partner posttraumatic stress symptoms, and whether targeted intervention teaching coping strategies and providing family support during the period of critical illness could impact these symptoms in duration or intensity.
The long-term impact of footshock stress on addiction-related behaviors in rats
2011, NeuropharmacologyCitation Excerpt :However, one important trauma-related dysfunction received little attention so far in the laboratory, namely the effect of traumatic experience in tests relevant to drug abuse. In humans, PTSD is highly co-morbid with substance abuse (Bronson et al., 2007; De Bellis, 2002; Foa et al., 2006; Keane et al., 1988; Kross et al., 2008; Nadelson, 1989; Owens et al., 2005). Drugs may be used by PTSD patients as a form of self-medication (Jacobsen et al., 2001; Staiger et al., 2009; Stewart et al., 1998).
Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit with COVID-19
2022, JAMA Internal MedicineReported burden on informal caregivers of ICU survivors: A literature review
2016, Critical Care