PTSD common in ICU survivors

Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes and assault. It's rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.

­­"PTSD can drastically impact a person's ability to communicate and connect with others, truly interrupting their lives and preventing experiences of joy," says Joe Bienvenu, M.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "This is why our findings are important and why it's so critical that we continue to research ways to prevent PTSD."

Similar research was done in years past, but there was much less data at that time. "We now have a larger data set to review and learn from," says Ann Parker, a fellow in the Johns Hopkins Medicine Division of Pulmonary and Critical Care Medicine. "These data could help us develop better prevention methods for ICU-induced PTSD."

Through a systematic literature review, the research team looked at 40 studies of 36 unique patient cohorts with a total of more than 3,000 patients who survived a critical illness and ICU stay.

The researchers excluded patients who had suffered a trauma, such as a car crash, or brain injury, because those patients' cognitive and psychological outcomes can be affected by the injury itself, rather than the critical illness/ICU stay. They found that the prevalence of PTSD in the studies ranged from 10 to 60 percent.

To pinpoint a more definitive estimate of PTSD prevalence, the researchers conducted a meta-analysis of a subset of the 40 studies. They selected six studies, with a total of about 450 patients, that used a PTSD measurement tool called the Impact of Event Scale between one and six months after ICU discharge. From these data, they found that one in four patients had symptoms of PTSD. The researchers repeated the same meta-analysis for studies that looked at patients seven to 12 months after an ICU stay and found that one in five patients had PTSD. "These rates are as high as you might see in combat soldiers or rape victims," says Dale Needham, M.D., a professor of medicine and of physical medicine and rehabilitation at Johns Hopkins. "Our clinicians and patients should know that the high risk of PTSD exists among patients surviving critical illness."

Fast Facts

Research finds that one-quarter of patients who survive a critical illness and an ICU stay experience PTSD.