Elsevier

Critical Care Clinics

Volume 24, Issue 4, October 2008, Pages 875-887
Critical Care Clinics

Posttraumatic Stress Disorder Following Critical Illness

https://doi.org/10.1016/j.ccc.2008.06.002Get rights and content

Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can occur after a traumatic event. Individuals exposed to traumatic events are at risk for PTSD and other psychologic morbidity, such as depression, panic disorder, generalized anxiety disorder, and substance abuse. The burden of PTSD can be high, with inability to work or return to prior levels of functioning. Emerging literature suggests a significantly increased risk for symptoms of PTSD among survivors of critical illness and the families of patients who survive or die after critical illness. This review summarizes these studies and provides suggestions for current clinical implications and for future research.

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)

  • M. Capuzzo et al.

    Post-traumatic stress disorder-related symptoms after intensive care

    Minerva Anestesiol

    (2005)
  • B.H. Cuthbertson et al.

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

    Intensive Care Med

    (2004)
  • J.P. Kress et al.

    The long-term psychological effects of daily sedative interruption on critically ill patients

    Am J Respir Crit Care Med

    (2003)
  • J.M. Eddleston et al.

    Survival, morbidity, and quality of life after discharge from intensive care

    Crit Care Med

    (2000)
  • J.E. Rattray et al.

    Predictors of emotional outcomes of intensive care

    Anaesthesia

    (2005)
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