title: Incidence and Risk Factors for Intensive Care Unit-related Post-traumatic Stress Disorder in Veterans and Civilians.
abstract: BACKGROUND
  The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort.
  
  
  OBJECTIVE
  To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians.
  
  
  METHODS
  This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization.
  
  
  RESULTS
  Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48).
  
  
  CONCLUSIONS
  This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.
authors.affiliation: 1 Surgical Services, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|2 Division of Trauma and Surgical Critical Care, Departments of Surgery and Neurosurgery, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mayur B
authors.identifier: http://orcid.org/0000-0001-5230-0871
authors.initials: MB
authors.lastname: Patel
authors.affiliation: 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.|5 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.affiliation: 6 Department of Rehabilitation and Aged Care Unit, Hospital Ancelle, Cremona, Italy.|7 Geriatric Research Group, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.affiliation: 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.affiliation: 8 Anesthesia Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|9 Division of Critical Care, Department of Anesthesiology, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Hughes
authors.affiliation: 10 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: 4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Kiehl
authors.affiliation: 11 George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, U.S. Department of Veterans Affairs, Salt Lake City, Utah.|12 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Elstad
authors.affiliation: 11 George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, U.S. Department of Veterans Affairs, Salt Lake City, Utah.
authors.forename: Mitzi L
authors.initials: ML
authors.lastname: Wasserstein
authors.affiliation: 13 Seattle Division, VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington.|14 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Goodman
authors.affiliation: 15 Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, U.S. Department of Veterans Affairs Medical Center, Durham, North Carolina.|16 Behavioral Medicine Division, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina; and.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
authors.affiliation: 10 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Rameela
authors.initials: R
authors.lastname: Chandrasekhar
authors.affiliation: 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|17 Division of General Internal Medicine and Public Health and Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.affiliation: 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: 8 Anesthesia Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.|9 Division of Critical Care, Department of Anesthesiology, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000523:psychology; D016638:Critical Illness / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*
keywords: intensive care unit; post-traumatic stress disorder; veterans