Incidence and Risk Factors for Intensive Care Unit–related Post-traumatic Stress Disorder in Veterans and Civilians

TLDR

ICU‑related PTSD incidence and risk factors have not been reported in a mixed veteran and civilian cohort. The study aimed to describe the incidence and risk factors for ICU‑related PTSD among veterans and civilians. A prospective, observational, multicenter cohort of adult ICU survivors from three Veterans Affairs and one civilian hospital was followed, with pre‑existing PTSD status classified and PTSD assessed at 3 and 12 months post‑hospitalization. Approximately 10 % of survivors developed ICU‑related PTSD at either 3‑ or 12‑month follow‑up, and pre‑existing PTSD and depression were independently associated with this outcome, whereas veteran status was not a consistent risk factor.

Abstract

Rationale: The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort.Objectives: To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians.Methods: This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization.Measurements and Main Results: Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48).Conclusions: This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.