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

Published online by Cambridge University Press:  26 February 2013

O. J. Bienvenu ,
J. Gellar ,
B. M. Althouse ,
E. Colantuoni ,
T. Sricharoenchai ,
P. A. Mendez-Tellez ,
C. Shanholtz ,
C. R. Dennison ,
P. J. Pronovost  and
D. M. Needham
O. J. Bienvenu*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
J. Gellar
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
B. M. Althouse
Affiliation:
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
E. Colantuoni
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
T. Sricharoenchai
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
P. A. Mendez-Tellez
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
C. Shanholtz
Affiliation:
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
C. R. Dennison
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins University School of Nursing, Baltimore, MD, USA
P. J. Pronovost
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
D. M. Needham
Affiliation:
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
*
*Address for correspondence: O. J. Bienvenu, M.D., Ph.D., 600 North Wolfe Street, Meyer 115, Baltimore, MD 21287, USA. (Email: jbienven@jhmi.edu)
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Abstract

Background

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.

Method

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’).

Results

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).

Conclusions

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.

Keywords

Acute lung injuryadultepidemiologyglucocorticoidsintensive care unitlongitudinal studypost-traumatic stress disorderprospective studyrespiratory distress syndromerisk factorssepsis
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 12 , December 2013 , pp. 2657 - 2671
Copyright
Copyright © Cambridge University Press 2013 

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