Original Articles

Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study

O. J. Bienvenu^a1a2a3 c1, J. Gellar^a2a4, B. M. Althouse^a5, E. Colantuoni^a2a4, T. Sricharoenchai^a2a6, P. A. Mendez-Tellez^a2a7, C. Shanholtz^a8, C. R. Dennison^a2a9, P. J. Pronovost^a2a7a10 and D. M. Needham^a2a6a11

^a1 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

^a2 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA

^a3 Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

^a4 Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

^a5 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

^a6 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

^a7 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

^a8 Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

^a9 Johns Hopkins University School of Nursing, Baltimore, MD, USA

^a10 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

^a11 Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA

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.

Method 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.

(Received October 14 2012)

(Revised January 18 2013)

(Accepted January 22 2013)

Key words

• Acute lung injury;
• adult;
• epidemiology;
• glucocorticoids;
• intensive care unit;
• longitudinal study;
• post-traumatic stress disorder;
• prospective study;
• respiratory distress syndrome;
• risk factors;
• sepsis

Correspondence

^c1 Address for correspondence: O. J. Bienvenu, M.D., Ph.D., 600 North Wolfe Street, Meyer 115, Baltimore, MD 21287, USA. (Email: jbienven@jhmi.edu)