Identification of post-traumatic stress disorder following ICU.

Abstract

At least 270 000 patients are admitted to intensive care units (ICUs) each year,1 and up to 27% of these develop post-ICU post-traumatic stress disorder (PTSD).2 This may be due to a variety of factors resulting in cumulative stress and trauma: fear of dying, invasive treatment, pain, delirium, inability to communicate, provision and withdrawal of sedation, experience of physical illness, immobility, and sensory and sleep deprivation.2,3 Patients’ families are also at risk of developing PTSD. One study suggested that the risk was as high as 33% for a family member with the main decision-making role,4 and this risk was increased when incomplete information was provided to family members, when the relative died on ICU, and when they were closely involved in management and end-of-life decisions (the latter could be because relatives felt more responsible for their family member’s management and therefore implicated in a negative outcome). There is evidence that PTSD following traumatic experiences results in impaired daily functioning and reduced life course opportunities.5 In addition to an ICU admission, other traumatic experiences may include road traffic accidents, assaults, and domestic violence, all of which GPs will encounter regularly. PTSD is also associated with high levels of disability, including up to 3.6 days of work lost per person per month, and annual lost productivity due to PTSD is estimated at over $3 billion in the US alone.5 Specialists in intensive care medicine typically focus on the prevention of short-term mortality and the improvement in the patient’s physical health. However, the intense focus on physical improvement can inadvertently result in neglect of the patient’s mental wellbeing, particularly in …