Gender differences in psychological morbidity and treatment in intensive care survivors - a cohort study

Critical Care

Peter Sackey¹  Örjan Sundin³  Elisabeth Hellgren¹  Matteo Bottai²  Anna Schandl¹ 

[1] Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden and The Institution of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institute, Solna, Sweden;The Unit of Biostatistics, The Institution of Environmental Medicine, Karolinska Institute, Solna, Sweden;Department of Psychology, Division of Social Sciences, Mid Sweden University, Östersund, Sweden

关键词: critical care;    follow-up;    multidisciplinary;    critical illness;    depression;    anxiety;    post-traumatic stress;   

Others  :  834097
DOI  :  10.1186/cc11338

 received in 2011-10-03, accepted in 2012-02-21,  发布年份 2012

【 摘 要 】

Introduction

Many hospitals have initiated follow-up to facilitate rehabilitation after critical illness and intensive care, although the efficacy of such an intervention is uncertain. Studies in trauma research indicate significant differences in psychological reactions to traumatic events between men and women. Our aim, in a quasi-experimental design, was to compare psychological morbidity and treatment effects between men and women enrolled in a multidisciplinary intensive care unit (ICU) follow-up programme (follow-up group) and ICU patients not offered such follow-up (control group).

Methods

Men and women treated more than four days in the ICU in 2006, before ICU follow-up started, were compared with men and women treated in 2007 and 2008, when all patients with an ICU stay of more than four days were offered ICU follow-up at 3, 6 and 12 months post-ICU. Fourteen months after ICU discharge, psychological problems were measured with Impact of Event Scale (IES) for posttraumatic stress and Hospital Anxiety and Depression Scale (HADS) for anxiety and depression.

Results

Women with no follow-up reported significantly higher IES scores than men. Women in the follow-up group reported significantly lower IES scores compared to women in the control group, both in crude analysis and after adjusting for significant confounders/predictors (age, ICU length of stay and previous psychological problems). Furthermore, the 75^th percentile for IES and HADS-Depression scores (high scores and degree of symptoms of psychological problems) in women in the follow-up group was lower than in those without follow-up (IES: -17.4 p, P <.01, HADS-depression: -4.9 p, P <.05). For men, no significant differences were found between the no follow-up and the follow-up group.

Conclusion

Psychological problems after critical illness and intensive care appear to be more common in women than in men. A multidisciplinary ICU follow-up may reduce the incidence of long-term symptoms of posttraumatic stress and depression for women.

【 授权许可】

   
2012 Schandl et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Desai SV, Law TJ, Needham DM: Long-term complications of critical care. Crit Care Med 2010, 39:371-379.
• [2]Girard TD, Shintani AK, Jackson JC, Gordon SM, Pun BT, Henderson MS, Dittus RS, Bernard GR, Ely EW: Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care 2007, 11:R28. BioMed Central Full Text
• [3]Scragg P, Jones A, Fauvel N: Psychological problems following ICU treatment. Anaesthesia 2001, 56:9-14.
• [4]Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995, 52:1048-1060.
• [5]Norris FH, Foster RG, Weishaar DL: The epidemiology of sex differences in PTSD across developmental, societal, and research contexts. In Gender and PTSD. Edited by Kimerling R, Ouimette P, Wolfe J. New York, NY: The Guilford Press; 2002:3-42.
• [6]Angus DC, Carlet J: Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 2003, 29:368-377.
• [7]National Institute for Health and Clinical Excellence (2009): Rehabilitation after Critical Illness [http://www.nice.org.uk/CG83] webcite
• [8]Svenska Intensivvårdsregistret - SIR: Riktlinje för PostIVA uppföljning [http://www.icuregswe.org/Documents/Guidelines/PostIVA_uppfoljning.pdf] webcite
• [9]Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, Hull A, Breeman S, Norrie J, Jenkinson D, Hernández R, Johnston M, Wilson E, Waldmann C, PRaCTICaL study group: The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ 2009, 339:b3723. Erratum in BMJ 2009, 339:b4445
• [10]Jones C, Humphris G, Griffiths R: Preliminary validation of the ICUM tool: a tool for assessing memory of the intensive care experience. Clin Intensive Care 2000, 11:251-255.
• [11]Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979, 41:209-218.
• [12]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67:361-370.
• [13]Schandl AR, Brattstrom OR, Svensson-Raskh A, Hellgren EM, Falkenhav MD, Sackey PV: Screening and treatment of problems after intensive care: a descriptive study of multidisciplinary follow-up. Intensive Crit Care Nurs 2011, 27:94-101.
• [14]Lisspers J, Nygren A, Soderman E: Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 1997, 96:281-286.
• [15]Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleston J, Waldmann C, Gager M: Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 2003, 31:2456-2461.
• [16]Bottai M, Cai B, McKeown RE: Logistic quantile regression for bounded outcomes. Stat Med 2010, 29:309-317.
• [17]Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998, 55:626-632.
• [18]Bryant RA, Mastrodomenico J, Felmingham KL, Hopwood S, Kenny L, Kandris E, Cahill C, Creamer M: Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry 2008, 65:659-667.
• [19]Jones C, Backman C, Capuzzo M, Egerod I, Flaatten H, Granja C, Rylander C, Griffiths RD: Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 2010, 14:R168. BioMed Central Full Text
• [20]Foa EB, Keane TM, Friedman MJ: Effective treatments for PTSD: Practical Guidelines from the International Society for Traumatic Stress Studies. New York: The Guilford Press; 2000.
• [21]Tarrier N, Pilgrim H, Sommerfield C, Faragher B, Reynolds M, Graham E, Barrowclough C: A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. J Consult Clin Psychol 1999, 67:13-18.
• [22]Bell EA, Roth MA, Weed G: Wartime stressors and health outcomes: women in the Persian Gulf War. J Psychosoc Nurs Ment Health Serv 1998, 36:19-25.
• [23]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383.