Posttraumatic Stress Disorder in Critical Illness Survivors. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Parker, Ann M.; Sricharoenchai, Thiti; Raparla, Sandeep; Schneck, Kyle W.; Bienvenu, O. Joseph; Needham, Dale M.
• Is Part Of: Critical care medicine. Volume 43:Issue 5(2015)
• Publication Date: 2015-05
• Subjects: Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000000882
• Languages: English
• ISSNs: 0090-3493

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.</p> </sec> <sec> <title>Data Sources:</title> <p>PubMed, Embase, CINAHL, PsycINFO, and Cochrane Library from inception through March 5, 2014.</p> </sec> <sec> <title>Study Selection:</title> <p>Eligible studies met the following criteria: 1) adult general/nonspecialty ICU, 2) validated posttraumatic stress disorder instrument greater than or equal to 1 month post-ICU, and 3) sample size greater than or equal to 10 patients.</p> </sec> <sec> <title>Data Extraction:</title> <p>Duplicate independent review and data abstraction from all eligible titles/abstracts/full-text articles.</p> </sec> <sec> <title>Data Synthesis:</title> <p>The search identified 2, 817 titles/abstracts, with 40 eligible articles on 36 unique cohorts (n = 4, 260 patients). The Impact of Event Scale was the most common posttraumatic stress disorder instrument. Between 1 and 6 months post-ICU (six studies; <italic>n</italic> = 456), the pooled mean (95% CI) Impact of Event Scale score was 20 (17–24), and the pooled prevalences of clinically important posttraumatic stress disorder symptoms (95% CI) were 25% (18–34%) and 44% (36–52%) using Impact of Event Scale thresholds greater than or equal to 35 and greater than or equal to 20, respectively. Between 7 and 12 months post-ICU (five studies; <italic>n</italic> = 698), the pooled mean Impact of Event Scale score was 17 (9–24), and pooled prevalences of posttraumatic stress disorder symptoms were 17% (10–26%) and 34% (22–50%), respectively. ICU risk factors for posttraumatic stress disorder symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences. Posttraumatic stress disorder symptoms were associated with worse quality of life. In European-based studies: 1) an ICU diary was associated with a significant reduction in posttraumatic stress disorder symptoms, 2) a self-help rehabilitation manual was associated with significant posttraumatic stress disorder symptom reduction at 2 months, but not 6 months; and 3) a nurse-led ICU follow-up clinic did not reduce posttraumatic stress disorder symptoms.</p> </sec> <sec> <title>Conclusions:</title> <p>Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.</p> </sec> </abstract>