Journal
GENERAL HOSPITAL PSYCHIATRY
Volume 30, Issue 5, Pages 421-434Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.genhosppsych.2008.05.006
Keywords
stress disorder; posttraumatic; critical care; intensive care unit; risk factors; outcome assessment (health care)
Categories
Funding
- NHLBI NIH HHS [R01 HL091760, P50 HL073994, R01 HL091760-01A1, P050 HL73994] Funding Source: Medline
- NIMH NIH HHS [K23 MH064543, K23 MH64543] Funding Source: Medline
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Objective: Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL). Methods: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals. Results: Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained clinically significant PTSD symptoms was 22% (n=1104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL. Conclusions: The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives) and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention. (C) 2008 Elsevier Inc. All rights reserved.
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