MedicalResearch.com Interview with:
Mayur Patel, MD, MPH, FACS
Assistant Professor of Surgery & Neurosurgery
Vanderbilt University Medical Center
Staff Surgeon and Surgical Intensivist
Nashville VA Medical Center
Medical Research: What is the background for this study?
Dr. Patel: Post-traumatic stress disorder (PTSD) can occur in patients after the traumatizing events of critical illness. Survivors of critical illness have reported PTSD symptoms months to even years after critical illness, possibly related to nightmare-like experiences, safety restraints creating communication barriers, and protective mechanical ventilation causing feelings of breathlessness and fear of imminent death. But, the epidemiology of PTSD after critical illness is unclear with wide ranging estimates (0-64%) and largely fails to distinguish past PTSD from new PTSD specifically resulting from the critical care experience.
Our study provides estimates on new cases of PTSD stemming specifically from the ICU experience. Pre-existing PTSD has rarely been systematically assessed in prior cohorts, and our work took extra effort to distinguish pre-existing PTSD from new PTSD cases. Civilian populations have dominated the literature of PTSD after critical illness, and this research is the first to also include the expanding and aging Veteran population.
Medical Research: What are the main findings?
Dr. Patel: Approximately one in ten patients is at risk of having new PTSD related to their ICU experience up to a year post-discharge, specifically a 6-12% cumulative incidence of ICU-related PTSD at one-year. This was the finding from our multicenter, prospective cohort research study of veterans and civilians, where a total of 181 patients were assessed at three months and 160 were further assessed at 12 months. Assessing risk factors for ICU-related PTSD, we found that pre-existing PTSD as well as prior depression were strong risk factors associated with ICU-related PTSD at 3 and 12 months post-discharge. Being a veteran did not increase risk of ICU-related PTSD, nor did duration of delirium, amount of pain medication, or amount of sedative.
Medical Research: What should clinicians and patients take away from your report?
Dr. Patel: One in ten patients is at risk of having new PTSD related to their ICU experience up to a year after hospitalization. Pre-existing mental health issues are magnified under the lens of critical illness, and refocused into new ICU-related PTSD.
Although lower than prior research and public perception suggests, the rate of ICU-related PTSD is very comparable to the 8 percent PTSD rates seen in current and former service members deployed to the recent Iraq and Afghanistan conflicts. 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, now totaling 5 million people every year.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Patel: Currently, the international psychological aftercare for ICU survivors is not organized proactively; rather, it 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 that the same should apply to the large and growing civilian and veteran populations of critically ill survivors.
Mayur B. Patel, James C. Jackson, Alessandro Morandi, Timothy D. Girard, Christopher G Hughes, Jennifer L Thompson, Amy L. Kiehl, Mark R. Elstad, Mitzi L. Wasserstein, Richard B Goodman, Jean C. Beckham, Rameela Chandrasekhar, Robert S. Dittus, E Wesley Ely, Pratik P Pandharipande. Incidence and Risk Factors for ICU-related Posttraumatic Stress Disorder In Veterans and Civilians. American Journal of Respiratory and Critical Care Medicine, 2016; DOI:10.1164/rccm.201506-1158OC
Mayur Patel, MD, MPH, FACS (2016). 10% of ICU Patients At Risk of Developing PTSD