O'Donnell Meaghan L, Creamer Mark, Holmes Alexander C N, Ellen Steven, McFarlane Alexander C, Judson Rodney, Silove Derrick, Bryant Richard A
Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, East Melnourne, Victoria, Australia.
J Trauma. 2010 Sep;69(3):627-32. doi: 10.1097/TA.0b013e3181bc0923.
This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission.
A two-group (those admitted to the ICU vs. those not admitted to ICU), prospective, cohort study of 829 randomly selected injury patients from five major trauma hospitals across Australia. We collected information on factors that may increase risk for PTSD including demographic variables (gender, age, income, education, and marital status), preinjury mental health status (prior trauma, psychiatric history, and prior social support), and injury characteristics (mild traumatic brain injury, injury severity, length of hospital admission, discharge destination, pain, and perceived threat). PTSD was measured at 12 months by structured clinical interview.
ICU patients were significantly more likely to have PTSD at 12 months than trauma controls (17% vs. 7%). Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic, preinjury mental health status, and injury characteristic variables.
Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.
本研究旨在确定因伤入住重症监护病房（ICU）后创伤后应激障碍（PTSD）的患病率，以调查受伤后入住ICU是否会增加患PTSD的风险，并确定入住ICU后PTSD的预测因素。
一项两组（入住ICU组与未入住ICU组）的前瞻性队列研究，对来自澳大利亚五家主要创伤医院的829名随机选择的受伤患者进行研究。我们收集了可能增加PTSD风险的因素信息，包括人口统计学变量（性别、年龄、收入、教育程度和婚姻状况）、伤前心理健康状况（既往创伤、精神病史和既往社会支持）以及损伤特征（轻度创伤性脑损伤、损伤严重程度、住院时间、出院目的地、疼痛和感知威胁）。在12个月时通过结构化临床访谈测量PTSD。
ICU患者在12个月时患PTSD的可能性显著高于创伤对照组（17%对7%）。逐步逻辑回归显示，在控制了人口统计学、伤前心理健康状况和损伤特征变量后，入住ICU对PTSD的发生有显著影响。
受伤患者如果入住ICU，日后患PTSD的可能性会增加两倍。鉴于我们控制了许多风险变量，似乎入住ICU本身可能会导致PTSD的发生。心理健康服务，如筛查和早期干预，可能对这一人群特别有用。
