Psychological morbidity a year after treatment in intensive care unit
Several studies have linked treatment in the Intensive Care Unit (ICU) with negative psychological outcomes. This study explores the prevalence of negative psychological outcomes in Greek patients (N=29), a year after treatment in ICU. Percentages of participants with anxiety [41%, 95% CI (22%, 60%)] and Post Traumatic Stress Disorder (PTSD) [34%, 95% CI (16%, 53%)] symptoms were similar to the related literature. Percentages of participants with depressive [17%, 95% CI (3%, 32%)] symptoms were rather low. Only 10% of participants reported absence of quality of live issues. Anxiety symptoms were related to desire to talk about the ICU experience (p=0.010), duration of propofol administration (p=0.018) and loss of employment (p=0.019) and negatively related to duration of stay in the ICU (p=0.025). PTSD symptoms were related to experiencing other stressors during the year after the ICU stay (p=0.001), social constraint (p=0.003), duration of propofol administration (p=0.004), loss of employ ment (p=0.020), low income (p=0.022) and negative ICU memo ries (p=0.029). Depressive symptoms were related to loss of employment (p=0.003), low income (p=0.029) and social con straint (p=0.033). Patients experience elevated levels of psycho logical symptoms long after they are discharged from the hospital. Several psychosocial factors emerged as important factors to con sider for predicting levels of distress.
1. Abraham, C. M., Obremskey, W. T., Song, Y., Jackson, J. C., Ely, E. W., & Archer, K. R. (2014). Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage. Archives of Physical Medicine and Rehabilitation, 95(12), 2382–2389. doi: 10.1016/j.apmr.2014.08.005.
2. Asimakopoulou, E., & Madianos, M. (2015). Posttraumatic Stress Disorder After Discharge From Intensive Care Units in Greater Athens Area. Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 22(4), 209–217. doi: 10.1097/JTN.0000000000000142.
3. Bienvenu, O. J., & Neufeld, K. J. (2011). Post-Traumatic Stress Disorder in Medical Settings: Focus on the Critically Ill. Current Psychiatry Reports, 13(1), 3–9. doi: 10.1007/s11920-010-0166-y.
4. Bienvenu, O. J., Gellar, J., Althouse, B. M., Colantuoni, E., Sricharoenchai, T., Mendez-Tellez, P. A., Shanholtz, C., Dennison, C. R., Pronovost, P. J., & Needham, D. M. (2013). Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychological Medicine, 43(12), 2657–2671. doi: 10.1017/S0033291713000214.
5. Cohee, A. A., Adams, R. N., Fife, B. L., Von Ah, D. M., Monahan, P. O., Zoppi, K. A., Cella, D., & Champion, V. L. (2017). The relationship between depressive symptoms and social cognitive processing in partners of long-term breast cancer survivors. Oncology Nursing Forum, 44(1), 44–51. doi: 10.1188/17.ONF.44-51.
6. Davydow, D. S., Gifford, J. M., Desai, S. V., Needham, D. M., & Bienvenu, O. J. (2008). Posttraumatic Stress Disorder in General Intensive Care Unit Survivors: A Systematic Review. General Hospital Psychiatry, 30(5), 421–434. doi: 10.1016/j.genhosppsych.2008.05.006.
7. Davydow, D. S., Zatzick, D. F., Hough, C. L., & Katon, W. J. (2013). A Longitudinal Investigation of Posttraumatic Stress and Depressive Symptoms over the Course of the Year Following Medical-Surgical Intensive Care Unit Admission. General Hospital Psychiatry, 35(3), 226–232. doi: 10.1016/j.genhosppsych.2012.12.005.
8. Dowdy, D.W., Eid, M. P., Sedrakyan, A., Mendez-Tellez, P. A., Pronovost, P. J., Herridge, M. S., & Needham, D. M. (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Medicine, 31, 611–620. doi: 10.1007/s00134-005-2592-6.
9. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour research and therapy, 38(4), 319–345. doi: 10.1016/s0005-7967(99)00123-0.
10. EuroQol Group (1990). EuroQol - a new facility for the measurement of health-related quality of life. Health policy (Amsterdam, Netherlands), 16(3), 199–208. doi: 10.1016/0168-8510(90)90421-9.
11. Hobfoll, S. E. (1989). Conservation of Resources: A New Attempt at Conceptualizing Stress. American Psychologist, 44(3), 513–24. doi: 10.1037/0003-066X.44.3.513.
12. Jackson, J. C., Jutte, J. E., Hunter, C. H., Ciccolella N., Warrington, H., Sevin, C., & Bienvenu, O. J. (2016). Posttraumatic stress disorder (PTSD) after critical illness: A conceptual review of distinct clinical issues and their implications. Rehabilitation Psychology, 61 (2), 132 – 140. doi: 10.1037/rep0000085.
13. Jones, C., Griffiths, R. D., Humphris, G., & Skirrow, P. M. (2001). Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical care medicine, 29(3), 573–580. doi: 10.1097/00003246-200103000-00019.
14. Kontodimopoulos, N., Pappa, E., Niakas, D., Yfantopoulos, J., Dimitrakaki, C., & Tountas, Y. (2008). Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value In Health, 11(7), 1162– 169. doi: 10.1111/j.1524-4733.2008.00356.x.
15. Lepore, S. J. (2001). A social–cognitive processing model of emotional adjustment to cancer. In A. Baum & B. L. Andersen (Eds.), Psychosocial interventions for cancer (pp. 99–116). Washington, DC: American Psychological Association. doi: 10.1037/10402-006.
16. Lepore, S. J., Silver, R. C., Wortman, C. B., & Wayment, H. A. (1996). Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. Journal of Personality and Social Psychology. 70(2), 271–282. doi:10.1037/0022-3514.70.2.271.
17. McGiffin, J. N., Galatzer-Levy, I. R., & Bonanno, G. A. (2016). Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses. Rehabilitation Psychology, 61(2), 120–131. doi:10.1037/rep0000073.
18. Michopoulos, I., Douzenis, A., Kalkavoura, C., Christodoulou, C., Michalopoulou, P., Kalemi, G., Fineti, K., Patapis, P., Protopapas, K., & Lykouras, L. (2008). Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Annals of General Psychiatry, 7, Article 4. doi: 10.1186/1744-859X-7-4.
19. Myhren, H., Ekeberg, O., Tøien, K., Karlsson, S., & Stokland, O. (2010). Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Critical Care, 14, Article R14. doi: 10.1186/cc8870.
20. Mystakidou, K., Tsilika, E., Parpa, E., Galanos, A. & Vlahos, L. (2007) Psychometric Properties of the Impact of Event Scale in Greek Cancer Patients. Journal of Pain and Symptom Management, 33(4), 454–461. doi: 10.1016/j.jpainsym-man.2006.09.023.
21. Nikayin, S., Rabiee, A., Hashem, M. D., Huang, M., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. General hospital psychiatry, 43, 23– 29.doi:10.1016/j.genhosppsych.2016.08.005.
22. Paparrigopoulos, T., Melissaki, A., Tzavellas, E., Karaiskos, D., Ilias, I., & Kokras, N. (2014) Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. International Journal of Psychiatry in Clinical Practice, 18(1), 25–31. doi: 10.3109/13651501.2013.855793.
23. Pryor, K. O., Root, J. C., Mehta, M., Stern, E., Pan, H., Veselis, R. A., & Silbersweig, D. A. (2015). Effect of propofol on the medial temporal lobe emotional memory system: a functional magnetic resonance imaging study in human subjects. British journal of anaesthesia, 115(1), 104–113. doi: 10.1093/bja/aev038.
24. Rabiee, A., Nikayin, S., Hashem, M. D., Huang, M., Dinglas, V. D., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis. Critical Care, 44(9), 1744–1753. doi: 10.1097/CCM.0000000000001811.
25. Rime, B. (1995). Mental rumination, social sharing, and the recovery from emotional exposure. In J. W. Pennebaker (Ed.), Emotion, disclosure, & health (pp. 271–291). Washington, DC: American Psychological Association. doi: 10.1037/10182-013.
26. Rini, C., & Schetter, C. D. (2010). The Effectiveness of Social Support Attempts in Intimate Relationships. In K. T. Sullivan, & J. Davila, (Eds.), Support Processes in Intimate Relationships (pp. 26–67). Oxford University Press. doi: 10.1093/acprof:oso/9780195380170.003.0002.
27. Schandl, A., Bottai, M., Hellgren, E., Sundin, O., & Sackey, P. V. (2013). Developing an early screening instrument for predicting psychological morbidity after critical illness. Critical Care, 17, Article R210. doi: 10.1186/cc13018.
28. Schelling, G., Kilger, E., Roozendaal, B., de Quervain, D. J., Briegel, J., Dagge, A., Rothenhäusler, H. B., Krauseneck, T., Nollert, G., & Kapfhammer, H. P. (2004). Stress doses of hydrocortisone, traumatic memories, and symptoms of post-traumatic stress disorder in patients after cardiac surgery: a randomized study. Biological Psychiatry, 55(6), 627–633. doi: 10.1016/j.biopsych.2003.09.014.
29. Stoll, C., Kapfhammer, H. P., Rothenhäusler, H. B., Haller, M., Briegel, J., Schmidt, M., Krauseneck, T., Durst, K., & Schelling, G. (1999). Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive care medicine, 25(7), 697–704. doi: 10.1007/s001340050932.
30. Usuki, M., Matsuoka, Y., Nishi, D., Yonemoto, N., Matsumura, K., Otomo, Y., Kim, Y., & Kanba, S. (2012). Potential impact of propofol immediately after motor vehicle accident on later symptoms of posttraumatic stress disorder at 6-month follow up: a retrospective study. Critical Care, 17, Article R196. doi: 10.1186/cc11681.
31. Wade, D., Hardy, R., Howell, D., & Mythen, M. (2013). Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiologica, 79(8), 944–963.
32. Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale – revised. In: J. P. Wilson & T .M. Keane (Eds.), Assessing psychological trauma and PTSD: A Practitioner’s Handbook (pp. 399 – 411). New York: Guilford Press.
33. Yfantopoulos, J. (2001). The Greek version of the EuroQol (EQ-5D) instrument. Archives of Hellenic Medicine, 18(2), 180–191.
34. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica Scandinavica, 67(6), 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.