Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem
1 Clinical Research Center of Excellence (CRCOE), VA Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), 1310 24. th Avenue, S., Nashville, TN 37212, USA
2 Division of Allergy/Pulmonary/Critical Care Medicine, Vanderbilt University, T1218 Medical Center North, Nashville, TN 37232-2650, USA
3 Center for Health Services Research, Vanderbilt University, 6100 Medical Center East, Nashville, TN 37232-8300, USA
4 Department of Psychiatry, 1601 23rd Avenue, South, Vanderbilt University School of Medicine, Nashville, TN 37212, USA
5 Department of Psychiatry, West Hospital, 1200 E. Broad, VCU Medical Center, Richmond, VA 23298, USA
6 VA Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), 1310 24th Avenue, S., Nashville, TN 37212, USA
7 Psychology Department and Neuroscience Center, 1082 SWKT, Brigham Young University, Provo, UT 84602, USA
8 Department of Medicine, Pulmonary and Critical Care Division, LDS Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84113, USA
Critical Care 2007, 11:R27 doi:10.1186/cc5707
See related commentary by Weinert and Meller, http://ccforum.com/content/11/1/118, related research by Girard et al, http://ccforum.com/content/11/1/R28, and related research by Boeret et al., http://ccforum.com/content/11/1/R30Published: 22 February 2007
Post-traumatic stress disorder (PTSD) is a potentially serious psychiatric disorder that has traditionally been associated with traumatic stressors such as participation in combat, violent assault, and survival of natural disasters. Recently, investigators have reported that the experience of critical illness can also lead to PTSD, although details of the association between critical illness and PTSD remain unclear.
We conducted keyword searches of MEDLINE and Psych Info and investigations of secondary references for all articles pertaining to PTSD in medical intensive care unit (ICU) survivors.
From 78 screened papers, 16 studies (representing 15 cohorts) and approximately 920 medical ICU patients met inclusion criteria. A total of 10 investigations used brief PTSD screening tools exclusively as opposed to more comprehensive diagnostic methods. Reported PTSD prevalence rates varied from 5% to 63%, with the three highest prevalence estimates occurring in studies with fewer than 30 patients. Loss to follow-up rates ranged from 10% to 70%, with average loss to follow-up rates exceeding 30%.
Exact PTSD prevalence rates cannot be determined due to methodological limitations such as selection bias, loss to follow-up, and the wide use of screening (as opposed to diagnostic) instruments. In general, the high prevalence rates reported in the literature are likely to be overestimates due to the limitations of the investigations conducted to date. Although PTSD may be a serious problem in some survivors of critical illness, data on the whole population are inconclusive. Because the magnitude of the problem posed by PTSD in survivors of critical illness is unknown, there remains a pressing need for larger and more methodologically rigorous investigations of PTSD in ICU survivors.