Post-traumatic stress disorder symptoms after acute lung injury

A 2-year prospective longitudinal study

Oscar J Bienvenu, J. Gellar, B. M. Althouse, Elizabeth Ann Colantuoni, T. Sricharoenchai, Pedro A Mendez Tellez, C. Shanholtz, Cheryl Renee Dennison-Himmelfarb, P. J. Pronovost, Dale Needham

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)2657-2671
Number of pages15
JournalPsychological Medicine
Volume43
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Acute Lung Injury
Post-Traumatic Stress Disorders
varespladib methyl
Intensive Care Units
Longitudinal Studies
Opiate Alkaloids
Prospective Studies
Odds Ratio
Confidence Intervals
Psychiatry
Critical Illness
Sepsis
Adrenal Cortex Hormones
Depression
Critical Care
Morphine
Survivors
Length of Stay
Cohort Studies

Keywords

  • Acute lung injury
  • adult
  • epidemiology
  • glucocorticoids
  • intensive care unit
  • longitudinal study
  • post-traumatic stress disorder
  • prospective study
  • respiratory distress syndrome
  • risk factors
  • sepsis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Post-traumatic stress disorder symptoms after acute lung injury : A 2-year prospective longitudinal study. / Bienvenu, Oscar J; Gellar, J.; Althouse, B. M.; Colantuoni, Elizabeth Ann; Sricharoenchai, T.; Mendez Tellez, Pedro A; Shanholtz, C.; Dennison-Himmelfarb, Cheryl Renee; Pronovost, P. J.; Needham, Dale.

In: Psychological Medicine, Vol. 43, No. 12, 12.2013, p. 2657-2671.

Research output: Contribution to journalArticle

@article{42324321b1494c19b557666f9e7cbe5d,
title = "Post-traumatic stress disorder symptoms after acute lung injury: A 2-year prospective longitudinal study",
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 injury, adult, epidemiology, glucocorticoids, intensive care unit, longitudinal study, post-traumatic stress disorder, prospective study, respiratory distress syndrome, risk factors, sepsis",
author = "Bienvenu, {Oscar J} and J. Gellar and Althouse, {B. M.} and Colantuoni, {Elizabeth Ann} and T. Sricharoenchai and {Mendez Tellez}, {Pedro A} and C. Shanholtz and Dennison-Himmelfarb, {Cheryl Renee} and Pronovost, {P. J.} and Dale Needham",
year = "2013",
month = "12",
doi = "10.1017/S0033291713000214",
language = "English (US)",
volume = "43",
pages = "2657--2671",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "Cambridge University Press",
number = "12",

}

TY - JOUR

T1 - Post-traumatic stress disorder symptoms after acute lung injury

T2 - A 2-year prospective longitudinal study

AU - Bienvenu, Oscar J

AU - Gellar, J.

AU - Althouse, B. M.

AU - Colantuoni, Elizabeth Ann

AU - Sricharoenchai, T.

AU - Mendez Tellez, Pedro A

AU - Shanholtz, C.

AU - Dennison-Himmelfarb, Cheryl Renee

AU - Pronovost, P. J.

AU - Needham, Dale

PY - 2013/12

Y1 - 2013/12

N2 - 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.

AB - 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.

KW - Acute lung injury

KW - adult

KW - epidemiology

KW - glucocorticoids

KW - intensive care unit

KW - longitudinal study

KW - post-traumatic stress disorder

KW - prospective study

KW - respiratory distress syndrome

KW - risk factors

KW - sepsis

UR - http://www.scopus.com/inward/record.url?scp=84887474876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887474876&partnerID=8YFLogxK

U2 - 10.1017/S0033291713000214

DO - 10.1017/S0033291713000214

M3 - Article

VL - 43

SP - 2657

EP - 2671

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 12

ER -