Post-traumatic Stress Disorder in Intensive Care Unit Survivors

  • J. Griffiths
  • A. M. Hull
  • B. H. Cuthbertson
Conference paper


Extended follow-up of survivors of intensive care unit (ICU) treatment has shown that many patients suffer long-term physical and psychological consequences that affect their quality of life [1]. One form of psychological morbidity, post-traumatic stress disorder, is increasingly reported in ICU survivors [2, 3, 4]. The aim of this chapter is to: (a) provide a brief summary of post-traumatic stress disorder and its diagnosis; (b) summarize existing research pertaining to ICU-related post-traumatic stress disorder and review the methodologies of the research; (c) provide an estimate of the prevalence of ICU-related post-traumatic stress disorder; (d) discuss the limitations of the current research into ICU-related post-traumatic stress disorder; and (e) provide a summary of potential risk factors for ICU-related post-traumatic stress disorder.


Intensive Care Unit Discharge Intensive Care Unit Survivor Matic Stress Disorder Davidson Trauma Scale Intensive Care Unit Experience 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Broomhead LR, Brett SJ (2002) Clinical review: Intensive care follow-up-what has it told us? Crit Care 6:411–417PubMedCrossRefGoogle Scholar
  2. 2.
    Cuthbertson BH, Hull A, Strachan M, Scott J (2004) Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 30:450–455PubMedCrossRefGoogle Scholar
  3. 3.
    Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G (2004) Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 161:45–52PubMedCrossRefGoogle Scholar
  4. 4.
    Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29:573–580PubMedCrossRefGoogle Scholar
  5. 5.
    American Psychiatric Association (1980) Diagnostic & Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
  6. 6.
    American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision. American Psychiatric Association, Washington, DCGoogle Scholar
  7. 7.
    Tedstone JE, Tarrier N (2003) Posttraumatic stress disorder following medical illness and treatment. Clin Psychol Rev 23:409–448PubMedCrossRefGoogle Scholar
  8. 8.
    Spitzer RL, Williams JB, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 49:624–629PubMedGoogle Scholar
  9. 9.
    Blake DD, Weathers FW, Nagy LM, et al (1995) The development of a Clinician-Administered post-traumatic stress disorder Scale. J Trauma Stress 8:75–90PubMedCrossRefGoogle Scholar
  10. 10.
    Davidson JR, Book SW, Colket JT, et al (1997) Assessment of a new self-rating scale for posttraumatic stress disorder. Psychol Med 27:153–160PubMedCrossRefGoogle Scholar
  11. 11.
    Horowitz M, Wilner W, Alvarez W (1979) Impact of Event Scale: A measure of subjective stress. Psychosom Med 41:209–218PubMedGoogle Scholar
  12. 12.
    Weiss D, Marmar C (1997) The Impact of Event Scale — Revised. In: Wilson J, Keane T (eds) Assessing Psychological Trauma and Post-Traumatic Stress Disorder. Guilford, New York, pp 399–411Google Scholar
  13. 13.
    Stoll C, Kapfhammer HP, Rothenhausler HB, et al (1999) Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 25:697–704PubMedCrossRefGoogle Scholar
  14. 14.
    Schelling G, Kilger E, Roozendaal B, et al (2004) Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 55:627–633PubMedCrossRefGoogle Scholar
  15. 15.
    Creamer M, McFarland A, Burgess P (2005) Psychopathology following trauma: the role of subjective experience. J Affect Disord 86:175–182PubMedCrossRefGoogle Scholar
  16. 16.
    Jackson J, Hart R, Gordon S, Hopkins R, Girard T, Ely E (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11:R27PubMedCrossRefGoogle Scholar
  17. 17.
    Griffiths J, Fortune G, Barber V, Young J (2007) The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 33:1506–1518PubMedCrossRefGoogle Scholar
  18. 18.
    Weis F, Kilger E, Roozendaal B, et al (2006) Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. J Thorac Cardiovasc Surg 131:277–282PubMedGoogle Scholar
  19. 19.
    Schelling G, Stoll C, Haller M, et al (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMedCrossRefGoogle Scholar
  20. 20.
    Schelling G, Stoll C, Kapfhammer HP, et al (1999) The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med 27:2678–2683PubMedCrossRefGoogle Scholar
  21. 21.
    Schelling G, Richter M, Roozendaal B, et al (2003) Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med 31:1971–1980PubMedCrossRefGoogle Scholar
  22. 22.
    Stoll C, Schelling G, Goetz AE, et al (2000) Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 120:505–512PubMedCrossRefGoogle Scholar
  23. 23.
    Schelling G, Briegel J, Roozendaal B, Stoll C, Rothenhausler HB, Kapfhammer HP (2001) The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry 50:978–985PubMedCrossRefGoogle Scholar
  24. 24.
    Hepp U, Moergeli H, Buchi S, Wittmann L, Schnyder U (2005) Coping with serious accidental injury: a one-year follow-up study. Psychother Psychosom 74:379–386PubMedCrossRefGoogle Scholar
  25. 25.
    Rothenhausler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP (2005) Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry 27:18–28PubMedCrossRefGoogle Scholar
  26. 26.
    Schnyder U, Morgeli H, Nigg C, et al (2000) Early psychological reactions to life-threatening injuries. Crit Care Med 28:86–92PubMedCrossRefGoogle Scholar
  27. 27.
    Schnyder U, Moergeli H, Klaghofer R, Buddeberg C (2001) Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. Am J Psychiatry 158:594–599PubMedCrossRefGoogle Scholar
  28. 28.
    Liberzon I, Abelson JL, Amdur RL, et al (2006) Increased psychiatric morbidity after abdominal aortic surgery: risk factors for stress-related disorders. J Vasc Surg 43:929–934PubMedCrossRefGoogle Scholar
  29. 29.
    Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care 168:1457–1461CrossRefGoogle Scholar
  30. 30.
    Badia-Castello M, Trujillano-Cabello J, Servia-Goixart L, March-Llanes J, Rodriguez-Pozo A (2006) Recall and memory after intensive care unit stay. Development of posttraumatic stress disorder. Med Clin (Barc) 126:561–566CrossRefGoogle Scholar
  31. 31.
    Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14PubMedCrossRefGoogle Scholar
  32. 32.
    Rattray JE, Johnston M, Wildsmith JA (2005) Predictors of emotional outcomes of intensive care. Anaesthesia 60:1085–1092PubMedCrossRefGoogle Scholar
  33. 33.
    Nickel M, Leiberich P, Nickel C, et al (2004) The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med 19:285–290PubMedCrossRefGoogle Scholar
  34. 34.
    Wehler M, Stolle M, Riek A, et al (2004) Post-traumatic stress disorder after medical intensive care Crit Care 8:R343CrossRefGoogle Scholar
  35. 35.
    Girard T, Shintani A, Jackson J, et al (2007) Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care 11:R28PubMedCrossRefGoogle Scholar
  36. 36.
    Mahler C, Boer K, Unlu C, et al (2005 ) Prevalence of symptoms related to post-traumatic stress disorder during long-term follow-up in patients after surgical treatment for secondary peritonitis. Crit Care 9:R243CrossRefGoogle Scholar
  37. 37.
    Capuzzo M, Valpondi V, Cingolani E, et al (2005) Post-traumatic stress disorder-related symptoms after intensive care. Minerva Anestesiol 71:167–179PubMedGoogle Scholar
  38. 38.
    Bennun I (2004) A critique of the research assessing post traumatic stress disorder in critical care patients. Care Crit Ill 20:102–107Google Scholar
  39. 39.
    Tedstone J, Tarrier N (1997) An investigation of the prevalence of psychological morbidity in burn injured patients. Burns 23:550–554PubMedCrossRefGoogle Scholar
  40. 40.
    Deja M, Denke C, Weber-Carstens S, et al (2006) Social support during intensive care unit stay might reduce the risk for the development of posttraumatic stress disorder and consequently improve health related quality of life in survivors of acute respiratory distress syndrome. Crit Care 10:R147PubMedCrossRefGoogle Scholar
  41. 41.
    Czarnocka J, Slade P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. Br J Clin Psychol 39 35–51PubMedCrossRefGoogle Scholar
  42. 42.
    Alonzo AA (2000) The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity. Soc Sci Med 50:1475–1484PubMedCrossRefGoogle Scholar
  43. 43.
    Klein S, Alexander DA, Hutchinson JD, Simpson JA, Simpson JM, Bell JS (2002) The Aberdeen Trauma Screening Index: an instrument to predict post-accident psychopathology. Psychol Med 32:863–871PubMedCrossRefGoogle Scholar
  44. 44.
    Rattray J, Johnston M, Wildsmith JA (2004) The intensive care experience: development of the ICE questionnaire. J Adv Nurs 47:64–73PubMedCrossRefGoogle Scholar
  45. 45.
    Nelson BJ, Weinert CR, Bury CL, Marinelli WA, Gross CR (2000) Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Crit Care Med 28:3626–3630PubMedCrossRefGoogle Scholar
  46. 46.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060PubMedGoogle Scholar
  47. 47.
    Shaw RJ, Harvey JE, Nelson KL, Gunary R, Kruk H, Steiner H (2001) Linguistic analysis to assess medically related posttraumatic stress symptoms. Psychosomatics 42:35–40PubMedCrossRefGoogle Scholar
  48. 48.
    Griffiths J, Gager M, Alder N, Fawcett D, Waldmann C, Quinlan J (2006) A self-report-based study of the incidence and associations of sexual dysfunction in survivors of intensive care treatment. Intensive Care Med 32:445–451PubMedCrossRefGoogle Scholar
  49. 49.
    Jones C, Skirrow P, Griffiths RD, et al (2003) Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 31:2456–2461PubMedCrossRefGoogle Scholar
  50. 50.
    Perrins J, King N, Collings J (1998) Assessment of long-term psychological well-being following intensive care. Intensive Crit Care Nurs 14:108–116PubMedCrossRefGoogle Scholar
  51. 51.
    Richter JC, Waydhas C, Pajonk FG (2006) Incidence of posttraumatic stress disorder after prolonged surgical intensive care unit treatment. Psychosom 47:223–230CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2008

Authors and Affiliations

  • J. Griffiths
    • 1
  • A. M. Hull
    • 2
  • B. H. Cuthbertson
    • 3
  1. 1.Nuffield Department of AnestheticsJohn Radcliffe HospitalOxfordUK
  2. 2.Consultant PsychiatristMurray Royal HospitalPerthUK
  3. 3.Health Services Research Unit, Health Sciences BuildingUniversity of AberdeenAberdeenUK

Personalised recommendations