In a first-of-its-kind study of veterans and civilians, researchers from Vanderbilt University Medical Center found one in 10 patients is at risk of having a new post-traumatic stress disorder (PTSD) following their time in the intensive care unit (ICU).
The study, published in the American Journal of Respiratory and Critical Care Medicine, found the cumulative incidence of PTSD following a critical illness and ICU experience was 6-12 percent and could occur up to one year after hospitalization.
Led by Dr. Mayur Patel, assistant professor of Surgery and Neurosurgery at VUMC and staff surgeon and surgical intensivist at the Nashville VA Medical Center, the researchers analyzed data from a cohort of medical and surgical ICU survivors enrolled in studies from three Veterans Affairs hospitals and one civilian hospital (MIND ICU study NCT00400062 and BRAIN-ICU study NCT00392795).
Using the PTSD Checklist from the DSM-IV to determine PTSD for this study, among PTSD measurements listed by the U.S. Department of Veterans Affairs’ National Center for PTSD, 181 patients were assessed at three months post-hospitalization, with 160 of those assessed further at 12 months.
The researchers found pre-existing PTSD and prior depression were strong risk factors associated with ICU-related PTSD at three and 12 months post-discharge. Further, it was found that being a veteran did not increase risk of ICU-related PTSD, nor did duration of delirium, pain medication or sedative dose.
These findings provide improved estimates on new cases of PTSD stemming specifically from the ICU experience and distinguished pre-existing PTSD from new PTSD cases. Further, the authors noted previous studies on PTSD after critical illness primarily included civilian populations, making this the first to include the expanding and aging veteran population.
“Although different than prior research and public perception suggests, the rate of ICU-related PTSD is very comparable to those seen in current and former service members deployed to the recent Iraq and Afghanistan conflicts,” Dr. Patel said. “It is important to understand more about PTSD following the traumatizing events of a critical illness so we can better support the growing number of ICU survivors.”
Patel also noted that currently, the international psychological aftercare for ICU survivors is not organized proactively but is largely reactive in response to disabling reports from survivors, caregivers and primary care providers.
“The Institute of Medicine in the United States has recommended a systematic collection, analysis and dissemination of data assessing the quality of post-conflict PTSD care in the military and veteran populations. We suggest the same should apply to the large civilian and veteran populations of critically ill survivors,” Dr. Patel said.
This study was funded by the National Institutes of Health (R01AG027472, R01HL111111, R01AG035117, K23AG034257, K23AG031322), Vanderbilt Faculty Research Scholars Program, the Foundation for Anesthesia Education and Research, the Veterans Affairs Clinical Science Research and Development Service (VA Career Development Award), and the VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC).