Psychological distress after severe trauma: a prospective 1-year follow-up study of a trauma intensive care unit population.
BACKGROUND
The aim of the study was to investigate the level of psychologic distress after trauma and intensive care unit (ICU) stay, memory from the ICU, and predictors for psychologic distress at 12 months.


METHODS
Prospective single center study in a trauma referral center for Eastern and Southern Norway. Participants were 150 trauma patients treated in an ICU for > 24 hours. Assessments were performed after discharge, at 3 months, and at 12 months using the Impact of Event Scale, Hospital Anxiety and Depression Scale, ICU memory tool, and Life Orientation Test-Revised.


RESULTS
At baseline, the mean Impact of Event scores were 22.7 decreasing to 18.4 at 12 months (p = 0.039). At 1-year follow-up, mean anxiety scores were 5.5 (95% confidence interval [CI]: 4.6-6.4) and depression scores 3.8 (95% CI: 3.1-4.5). Factual memories from ICU (odds ratio [OR] 6.58, [95% CI: 2.01-21.52], p = 0.002), low educational level (OR 0.29, [95% CI: 0.10-0.86] p = 0.025), not having care of children (OR 0.14, [95% CI: 0.04-0.47] p = 0.002), and female gender (OR 2.95, [95% CI: 1.04-8.34] p = 0.042) predicted posttraumatic stress symptoms at 12 months. Anxiety at 12 months was predicted only by pessimism (OR 0.83, [95% CI: 0.75-0.93] p = 0.001). Depression at 12 months was predicted by being out of work before the injury (OR 3.64, [95% CI: 1.11-11.94] p = 0.033) and pessimism (OR 0.83, [95% CI: 0.73-0.93] p = 0.002).


CONCLUSIONS
Many patients suffer from posttraumatic stress symptoms, anxiety, and depression after trauma and ICU stay. The strongest predictors of psychologic distress 12 months after discharge were having factual memories from the ICU stay, being pessimistic, and being out of work before the injury.
Tøien
Kirsti
K
Intensive Care Unit, Oslo University Hospital, Ulleval, Oslo, Norway. kirsti.toien@uus.no
Myhren
Hilde
H
Bredal
Inger Schou
IS
Skogstad
Laila
L
Sandvik
Leiv
L
Ekeberg
Øivind
Ø
D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology* / Q000628:therapy