title: In ICU state anxiety is not associated with posttraumatic stress symptoms over six months after ICU discharge: A prospective study.
abstract: BACKGROUND
  Posttraumatic stress symptoms are common after intensive care treatment. The influence of anxiety during critical illness on the development of posttraumatic stress symptoms needs to be investigated.
  
  
  OBJECTIVE
  To determine the association between anxiety during critical illness (state and trait components) and posttraumatic stress symptoms over six months after ICU discharge.
  
  
  METHODS
  Prospective study including 141 patients admitted ≥24h to a closed mixed adult ICU in a tertiary hospital. State anxiety was assessed with the Faces Anxiety Scale during ICU stay. Trait anxiety was measured with the State-Trait Anxiety Inventory Form Y-2. Posttraumatic stress symptoms were measured at three and six months after ICU discharge using the Post-Traumatic Stress Symptoms 10-Question Inventory. Clinical and demographical data were also collected. Mixed effect regression models were used to determine if state and trait anxiety were factors significantly associated with posttraumatic stress symptoms over time.
  
  
  RESULTS
  Moderate to severe levels of state anxiety in ICU were reported by 81 (57%) participants. Levels of trait anxiety (median 36 IQR: 29-47) were similar to the Australian population. High levels of posttraumatic stress symptoms occurred at three (n=19, 19%) and six months (n=15, 17%). Factors independently associated with posttraumatic stress symptoms were trait anxiety (2.2; 95% CI, 0.3-4.1; p=0.02), symptoms of anxiety after ICU discharge (0.6; 95% CI, 0.2-1.1; p=0.005), younger age (-1.4; 95% CI, -2.6 to -0.2; p=0.02) and evidence of mental health treatment prior to the ICU admission (5.2; 95% CI, 1.5-8.9; p=0.006).
  
  
  CONCLUSIONS
  Posttraumatic stress symptoms occurred in a significant proportion of ICU survivors and were significantly associated with higher levels of trait anxiety, younger age, mental health treatment prior to the ICU admission and more symptoms of anxiety after ICU discharge. Early assessment and interventions directed to reduce state and trait anxiety in ICU survivors may be of benefit.
authors.affiliation: School of Nursing and Midwifery, Griffith University, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia; Princess Alexandra Hospital, Australia. Electronic address: m.castillo@griffith.edu.au.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Castillo
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia. Electronic address: m.cooke@griffith.edu.au.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Cooke
authors.affiliation: Princess Alexandra Hospital, Australia; School of Nursing and Midwifery, Griffith University, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia. Electronic address: bonnie.macfarlane@griffith.edu.au.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Macfarlane
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia; School of Health Sciences, City University London, United Kingdom; Princess Alexandra Hospital, Australia. Electronic address: l.aitken@griffith.edu.au.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
mesh_terms: D018806:APACHE; D001007:Anxiety / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D016638:Critical Illness / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
keywords: Critically ill; Intensive care unit; Posttraumatic stress symptoms; State anxiety; Trait anxiety