Intensive Care Unit, Ulleval, Oslo University Hospital, Kirkeveien 177, 0407 Oslo, Norway.
Crit Care. 2010;14(1):R14. doi: 10.1186/cc8870. Epub 2010 Feb 8.
To study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.
Of 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was > or = 35. Case level of HADS-Anxiety or Depression was > or = 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.
Mean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES > or = 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in posttraumatic stress, anxiety or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of posttraumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.
The mean level of posttraumatic stress symptoms in patients one year following ICU treatment was high and one of four were above case level Predictors of posttraumatic stress symptoms were mainly demographics and experiences during hospital stay whereas clinical injury related variables were insignificant. Pessimism was a predictor of posttraumatic stress, anxiety and depression symptoms. A subgroup of patients developed clinically significant distress symptoms during the follow-up period.
研究创伤后应激、焦虑和抑郁症状在重症监护病房（ICU）出院后第一年的医疗、外科和创伤患者中的水平和预测因素。
在 255 名患者中，有 194 名在 12 个月时参与了研究。患者在 4-6 周、3 个月和 12 个月时完成了事件影响量表（IES）、医院焦虑抑郁量表（HADS）和生活取向测试（LOT），并在第一次评估（基线）时使用 ICU 记忆工具。创伤后应激症状的病例水平，具有高创伤后应激障碍（PTSD）发生概率的病例水平> = 35。HADS 焦虑或抑郁的病例水平> = 11。ICU 住院期间疼痛记忆在基线时采用 5 点李克特量表（0-低至 4-高）进行测量。对逻辑回归分析中的患者人口统计学和临床变量进行了控制。
ICU 治疗一年后，IES 平均得分为 22.5（95%CI 20.0-25.1），27%（48/180）的得分高于病例水平，IES > = 35。在三个时间点，IES 平均得分无显著差异（P = 0.388）。在亚组中，27/170（16%）患者的 IES 评分从 11 增加到 32，P < 0.001。在医疗、外科和创伤患者之间未发现创伤后应激、焦虑或抑郁的差异。高教育水平（OR 0.4，95%CI 0.2-1.0）、人格特质（乐观）（OR 0.9，95%CI 0.8-1.0）、事实记忆（OR 6.6，95%CI 1.4-31.0）和疼痛记忆（OR 1.5，95%CI 1.1-2.0）是一年后创伤后应激症状的独立预测因素。乐观是焦虑（OR 0.8，0.8-0.9）和抑郁症状（OR 0.8，0.8-0.9）一年后减少的一个强有力的预测因素。
ICU 治疗一年后患者创伤后应激症状的平均水平较高，其中四分之一的患者达到病例水平。创伤后应激症状的预测因素主要是人口统计学和住院期间的经历，而临床损伤相关变量则不显著。悲观是创伤后应激、焦虑和抑郁症状的预测因素。有一部分患者在随访期间出现了明显的临床困扰症状。
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