Pilot exploration of post-traumatic stress symptoms in intensive care unit survivors in Cyprus.

Abstract

Approximately, 20% of intensive care unit (ICU) survivors develop post-traumatic stress disorder (PTSD) symptoms. Although Davidson Trauma Scale (DTS) provides a comprehensive approach to PSTD symptoms, there is no evidence on DTS-I-M use in ICU survivors. To validate the modified intensity Davidson Trauma Scale (DTS-I-M) (wherein the frequency and severity subscales are combined to express symptoms intensity) in a convenience sample of ICU survivors in Cyprus, and to explore the prevalence of PTSD symptoms and related predictors. An instrument validation design, along with a cross-sectional, correlational study design was employed. Translation and cultural adaptation of the instrument were achieved through a group of experts and pilot testing. The DTS-I-M was administered via telephone. Participants' clinical data (length of ICU stay [LOS], mechanical ventilation duration [MVD], admission diagnosis, medication history) and demographics (age, gender) were collected. Non-parametric comparisons, and regression analyses to identify predictors of DTS-I-M scores and PTSD symptoms were employed. The Cypriot DTS-I-M version demonstrated high test-retest (Pearson's r = 0.928, P < .001) and internal consistency (Cronbach's [α] alpha = .97) reliability in a sample of 69 ICU survivors (62.7% response). About 36.2% of participants reported PTSD symptoms. Factor analysis confirmed the construct validity of the DTS-I-M, and a 3-factor structure (encompassing intrusive, avoidance, hyperarousal, mood, and cognitive symptoms). In a multiple regression, MVD (B = -3.11, OR [95% CI] = 22.58 [3.07-166.09, P = .002]) and LOS (r2 = 0.302, P = .002) were statistically significant predictors of DTS-I-M score. We confirm the applicability of the DTS-I-M for the assessment of PTSD symptoms in ICU survivors; and offer preliminary evidence on the prevalence and predictors of post-ICU PTSD symptoms in Cyprus. DTS-I-M is an appropriate screening tool for PTSD symptoms after ICU hospitalization. Patients with longer MVD and LOS are at higher risk for post-ICU PTSD symptoms and seem to experience more intense relevant symptoms.