Wade, D. (2011) What explains the prevalence of post-traumatic stress disorder, depression, anxiety and poor quality of life after intensive care? An investigation of clinical, psychological and sociodemographic risk factors. Doctoral thesis, UCL (University College London).
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Although many lives are saved in intensive care, patients frequently fail to make a good recovery. In addition to physical weakness and cognitive impairment, patients suffer from clinical anxiety, depression and PTSD. The aim of this PhD was to establish the prevalence of poor mental health after intensive care and identify clinical, psychological and socio-demographic risk factors. First I carried out a systematic review of post-ICU psycho-social outcomes but found the quality of studies was variable and few consistent risk factors were identified. I subsequently conducted a prospective cohort study of 157 intensive care patients who were assessed for mood, stress, delirium and memory in the ICU. Clinical and socio-demographic data were recorded. At three months, 64% completed valid measures of PTSD, depression and anxiety, and socio-economic circumstances (SEC). Incidence of mood disturbance, delirium and physical stress in the ICU were 78%, 66% and 77% respectively. At three months, prevalence of PTSD was 27.1% (95%CIs: 18.3, 35.9%), depression 46.3% (95%CIs: 36.5, 56.1%) and anxiety 44.4% (95%CIs: 34.6%, 54.2%). A total of 55% of patients had at least one outcome. PTSD was predicted by number of organs supported, drug groups used and sepsis bio-markers. Strongest clinical predictors were days of sedation (PTSD), benzodiazepine usage (depression), inotropes (anxiety) and steroids (better physical HRQL). SEC was a risk factor for depression, anxiety and mental HRQL. Psychological predictors including ICU mood, stress, delirium and memories were highly correlated with outcomes and partially mediated the relationships between clinical factors and outcomes. A qualitative study of 17 patients with intrusive memories of ICU at three months revealed patients had highly disturbing hallucinatory flash-backs or distressing recurring images of bleeding, choking, tubes and pain. The PhD highlighted the need to reduce ICU stress and identified modifiable risk factors that could inform clinical interventions to help patients.
|Title:||What explains the prevalence of post-traumatic stress disorder, depression, anxiety and poor quality of life after intensive care? An investigation of clinical, psychological and sociodemographic risk factors|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Epidemiology and Public Health|
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