Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study

• Published in: Psychological medicine Vol. 43; no. 12; p. 2657
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England 01-12-2013
• Subjects: Acute Lung Injury - complications; Acute Lung Injury - drug therapy; Acute Lung Injury - epidemiology; Adult; Analgesics, Opioid - administration & dosage; Baltimore - epidemiology; Depression - epidemiology; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Middle Aged; Patient Outcome Assessment; Prevalence; Prospective Studies; Risk Factors; Sepsis - epidemiology; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Time Factors; Baltimore
• ISSN: 1469-8978
• DOI: 10.1017/S0033291713000214

Survivors of critical illnesses often have clinically significant post-traumatic stress disorder (PTSD) symptoms. This study describes the 2-year prevalence and duration of PTSD symptoms after acute lung injury (ALI), and examines patient baseline and critical illness/intensive care-related risk factors.
This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12 and 24 months after ALI onset. The outcome of interest was an Impact of Events Scale - Revised (IES-R) mean score ≥1.6 ('PTSD symptoms').
During the 2-year follow-up, 66/186 patients (35%) had PTSD symptoms, with the greatest prevalence by the 3-month follow-up. Fifty-six patients with post-ALI PTSD symptoms survived to the 24-month follow-up, and 35 (62%) of these had PTSD symptoms at the 24-month follow-up; 50% had taken psychiatric medications and 40% had seen a psychiatrist since hospital discharge. Risk/protective factors for PTSD symptoms were pre-ALI depression [hazard odds ratio (OR) 1.96, 95% confidence interval (CI) 1.06-3.64], ICU length of stay (for a doubling of days, OR 1.39, 95% CI 1.06-1.83), proportion of ICU days with sepsis (per decile, OR 1.08, 95% CI 1.00-1.16), high ICU opiate doses (mean morphine equivalent ≥100 mg/day, OR 2.13, 95% CI 1.02-4.42) and proportion of ICU days on opiates (per decile, OR 0.83, 95% CI 0.74-0.94) or corticosteroids (per decile, OR 0.91, 95% CI 0.84-0.99).
PTSD symptoms are common, long-lasting and associated with psychiatric treatment during the first 2 years after ALI. Risk factors include pre-ALI depression, durations of stay and sepsis in the ICU, and administration of high-dose opiates in the ICU. Protective factors include durations of opiate and corticosteroid administration in the ICU.