Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk?
BACKGROUND
This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission.


METHODS
A two-group (those admitted to the ICU vs. those not admitted to ICU), prospective, cohort study of 829 randomly selected injury patients from five major trauma hospitals across Australia. We collected information on factors that may increase risk for PTSD including demographic variables (gender, age, income, education, and marital status), preinjury mental health status (prior trauma, psychiatric history, and prior social support), and injury characteristics (mild traumatic brain injury, injury severity, length of hospital admission, discharge destination, pain, and perceived threat). PTSD was measured at 12 months by structured clinical interview.


RESULTS
ICU patients were significantly more likely to have PTSD at 12 months than trauma controls (17% vs. 7%). Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic, preinjury mental health status, and injury characteristic variables.


CONCLUSIONS
Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.
O'Donnell
Meaghan L
ML
Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, East Melnourne, Victoria, Australia. mod@unimelb.edu.au
Creamer
Mark
M
Holmes
Alexander C N
AC
Ellen
Steven
S
McFarlane
Alexander C
AC
Judson
Rodney
R
Silove
Derrick
D
Bryant
Richard A
RA
D000328:Adult; D000367:Age Factors; D001315:Australia; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D017533:Marital Status; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology* / Q000628:therapy