| 1. |
- Schandl, Anna, et al.
(author)
-
Developing an early screening instrument for predicting psychological morbidity after critical illness
- 2013
-
In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 17:5, s. Art. no. R210-
-
Journal article (peer-reviewed)abstract
- Introduction: Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression. Methods: Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression. Results: Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales >= 8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%. Conclusion: The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.
|
|
| 2. |
- Schandl, Anna, et al.
(author)
-
Gender differences in psychological morbidity and treatment in intensive care survivors - a cohort study
- 2012
-
In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 16:3, s. Art. no. R80-
-
Journal article (peer-reviewed)abstract
- IntroductionMany 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 was, in a quasi-experimental design, 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).MethodsMen and women treated > 4 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 ICU stay > 4 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.ResultsWomen 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 75th 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.ConclusionPsychological 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.
|
|
