Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge
Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge
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DOI：
10.1186/cc8870
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发表时间：
2010-01-01
期刊：
影响因子：
15.1
通讯作者：
Stokland, Olav
中科院分区：
文献类型：
--
作者：
Myhren, Hilde;Ekeberg, Oivind;Stokland, Olav
简介：研究内科、外科和创伤患者在重症监护病房（ICU）出院后第一年的创伤后应激、焦虑和抑郁症状水平及其预测因素。患者在4 - 6周、3个月和12个月完成事件影响量表（IES）、医院焦虑和抑郁量表（HADS）、生活定向测验（LOT），并在首次评估（基线）时完成ICU记忆工具。创伤后应激障碍（PTSD）概率较高的创伤后应激症状的病例水平>= 35。HADS-焦虑或抑郁的病例水平>= 11。在ICU住院期间，在基线时采用5分Likert量表（0-低至4-高）测量疼痛记忆。患者的人口统计学和临床变量控制在logistic回归analysis.Results：平均IES评分ICU治疗后一年为22.5（95%CI 20.0至25.1）和27%（48/180）高于病例水平，IES >= 35。三个时间点的IES平均评分无显著差异（P = 0.388）。在一个亚组中，27/170（16%）患者IES评分从11增加到32，P < 0.001。内科、外科和创伤患者在创伤后应激、焦虑或抑郁方面没有差异。（OR 0.4，95%CI 0.2 - 1.0），人格特质（乐观）OR 0.9，95%CI 0.8 - 1.0）、事实回忆（OR 6.6，95%CI 1.4 - 31.0）和疼痛记忆（OR 1.5，95%CI 1.1 - 2.0）是创伤后应激症状的独立预测因子。乐观是减少焦虑的一个强有力的预测因素（OR 0.8，0.8至0.9）和抑郁症状（OR 0.8，0.8 ~ 0.9）。结论：ICU治疗一年后患者的创伤后应激症状平均水平较高，四分之一高于病例水平。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，临床损伤相关变量不显著。悲观是创伤后应激、焦虑和抑郁症状的预测因子。在随访期间，一个亚组的患者出现了具有临床意义的痛苦症状。
Introduction: 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.Methods: 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 >= 35. Case level of HADS-Anxiety or Depression was >= 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.Results: 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 >= 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.Conclusions: 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.