title: Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study.
abstract: BACKGROUND
  Survivors of critical illnesses often have clinically significant post-traumatic stress disorder (PTSD) symptoms. This study describes the 2-year prevalence and duration of PTSD symptoms after acute lung injury (ALI), and examines patient baseline and critical illness/intensive care-related risk factors.
  
  
  METHODS
  This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12 and 24 months after ALI onset. The outcome of interest was an Impact of Events Scale - Revised (IES-R) mean score ≥1.6 ('PTSD symptoms').
  
  
  RESULTS
  During the 2-year follow-up, 66/186 patients (35%) had PTSD symptoms, with the greatest prevalence by the 3-month follow-up. Fifty-six patients with post-ALI PTSD symptoms survived to the 24-month follow-up, and 35 (62%) of these had PTSD symptoms at the 24-month follow-up; 50% had taken psychiatric medications and 40% had seen a psychiatrist since hospital discharge. Risk/protective factors for PTSD symptoms were pre-ALI depression [hazard odds ratio (OR) 1.96, 95% confidence interval (CI) 1.06-3.64], ICU length of stay (for a doubling of days, OR 1.39, 95% CI 1.06-1.83), proportion of ICU days with sepsis (per decile, OR 1.08, 95% CI 1.00-1.16), high ICU opiate doses (mean morphine equivalent ≥100 mg/day, OR 2.13, 95% CI 1.02-4.42) and proportion of ICU days on opiates (per decile, OR 0.83, 95% CI 0.74-0.94) or corticosteroids (per decile, OR 0.91, 95% CI 0.84-0.99).
  
  
  CONCLUSIONS
  PTSD symptoms are common, long-lasting and associated with psychiatric treatment during the first 2 years after ALI. Risk factors include pre-ALI depression, durations of stay and sepsis in the ICU, and administration of high-dose opiates in the ICU. Protective factors include durations of opiate and corticosteroid administration in the ICU.
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: O J
authors: OJ
authors: Bienvenu
authors: J
authors: J
authors: Gellar
authors: B M
authors: BM
authors: Althouse
authors: E
authors: E
authors: Colantuoni
authors: T
authors: T
authors: Sricharoenchai
authors: P A
authors: PA
authors: Mendez-Tellez
authors: C
authors: C
authors: Shanholtz
authors: C R
authors: CR
authors: Dennison
authors: P J
authors: PJ
authors: Pronovost
authors: D M
authors: DM
authors: Needham
mesh_terms: D055371:Acute Lung Injury / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D015142:Baltimore / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D005938:Glucocorticoids