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Intensive Care Medicine

, 35:2078 | Cite as

Patients’ memory and psychological distress after ICU stay compared with expectations of the relatives

  • Hilde MyhrenEmail author
  • Kirsti Tøien
  • Øivind Ekeberg
  • Susanne Karlsson
  • Leiv Sandvik
  • Olav Stokland
Original

Abstract

Purpose

To compare patients’ psychological distress and memories from intensive care unit (ICU) treatment 4–6 weeks after ICU discharge with expectations of their relatives. Further, to explore the relationship between personality traits and ICU memories with psychological distress.

Methods

A cross-sectional study of 255 patients and 298 relatives. The questionnaire included: hospital anxiety and depression scale (HADS), impact of event scale (IES), life orientation test, ICU memory tool and memory of ICU; technical procedures, pain, lack of control and inability to express needs. Relatives were assessed for their expectations of the patients’ memories and psychological distress.

Results

Twenty-five percent of the patients reported severe posttraumatic stress symptoms, IES-total ≥ 35. The levels of anxiety and depression were significantly higher than in the general population, mean anxiety was 5.6 versus 4.2 (p < 0.001), and mean depression was 4.8 versus 3.5 (p < 0.001). Relatives expected more psychological distress and the relatives thought the patient was less able to express needs than the patients reported (p < 0.001). Higher age, unemployment, respirator treatment, pessimism, memory of pain, lack of control and inability to express needs were independent predictors of posttraumatic stress symptoms (p < 0.01).

Conclusions

Psychological distress symptoms were frequent among ICU survivors. Relatives expected the patients to be more distressed after ICU treatment than the patients reported. The strongest predictors of posttraumatic stress symptoms from the ICU were memoris about pain, lack of control and inability to express needs. Pessimism may be a reason for psychological distress and should be addressed during follow up, as pessimistic patients may need more motivation and support.

Keywords

Anxiety Posttraumatic stress Patients Relatives Pessimism Memory Q 

Supplementary material

134_2009_1614_MOESM1_ESM.doc (31 kb)
(DOC 31 kb)

References

  1. 1.
    Szokol JW, Vender JS (2001) Anxiety, delirium, and pain in the intensive care unit. Crit Care Clin 17:821–842CrossRefPubMedGoogle Scholar
  2. 2.
    Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14CrossRefPubMedGoogle Scholar
  3. 3.
    Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD (2007) Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med 33:978–985CrossRefPubMedGoogle Scholar
  4. 4.
    Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleston J, Waldmann C, Gager M (2003) Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 31:2456–2461CrossRefPubMedGoogle Scholar
  5. 5.
    Cuthbertson BH, Hull A, Strachan M, Scott J (2004) Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 30:450–455CrossRefPubMedGoogle Scholar
  6. 6.
    Capuzzo M, Valpondi V, Cingolani E, Gianstefani G, De LS, Grassi L, Alvisi R (2005) Post-traumatic stress disorder-related symptoms after intensive care. Minerva Anestesiol 71:167–179PubMedGoogle Scholar
  7. 7.
    Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659CrossRefPubMedGoogle Scholar
  8. 8.
    Myhren H, Ekeberg O, Langen I, Stokland O (2004) Emotional strain, communication, and satisfaction of family members in the intensive care unit compared with expectations of the medical staff: experiences from a Norwegian University Hospital. Intensive Care Med 30:1791–1798CrossRefPubMedGoogle Scholar
  9. 9.
    Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Org, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994CrossRefPubMedGoogle Scholar
  10. 10.
    Riggio RE, Singer RD, Hartman K, Sneider R (1982) Psychological issues in the care of critically ill respirator patients: differential perceptions of patients, relatives, and staff. Psychol Rep 51:363–369PubMedGoogle Scholar
  11. 11.
    Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Ely EW (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11:R27CrossRefPubMedGoogle Scholar
  12. 12.
    Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, Costa-Pereira A (2008) Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med 36:2801–2809CrossRefPubMedGoogle Scholar
  13. 13.
    Gil S, Caspi Y, Ben-Ari IZ, Koren D, Klein E (2005) Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study. Am J Psychiatry 162:963–969CrossRefPubMedGoogle Scholar
  14. 14.
    Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29:573–580CrossRefPubMedGoogle Scholar
  15. 15.
    Scheier MF, Matthews KA, Owens JF, Schulz R, Bridges MW, Magovern GJ, Carver CS (1999) Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med 159:829–835CrossRefPubMedGoogle Scholar
  16. 16.
    Schou I, Ekeberg O, Ruland CM, Sandvik L, Karesen R (2004) Pessimism as a predictor of emotional morbidity one year following breast cancer surgery. Psychooncology 13:309–320CrossRefPubMedGoogle Scholar
  17. 17.
    Le G Jr, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefGoogle Scholar
  18. 18.
    Reis MD, Moreno R, Iapichino G (1997) Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 23:760–765CrossRefGoogle Scholar
  19. 19.
    Langen I, Myhren H, Ekeberg O, Stokland O (2006) Patient’s satisfaction and distress compared with expectations of the medical staff. Patient Educ Couns 63:118–125CrossRefPubMedGoogle Scholar
  20. 20.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar
  21. 21.
    Herrmann C (1997) International experiences with the hospital anxiety and depression scale—a review of validation data and clinical results. J Psychosom Res 42:17–41CrossRefPubMedGoogle Scholar
  22. 22.
    Bjelland I (2004) Anxiety and depression in the general population: issues related to assessment, comorbidity, and risk factors. Doctoral dissertation. University og Bergen, Bergen, NorwayGoogle Scholar
  23. 23.
    Sundin EC, Horowitz MJ (2002) Impact of event scale: psychometric properties. Br J Psychiatry 180:205–209CrossRefPubMedGoogle Scholar
  24. 24.
    Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218PubMedGoogle Scholar
  25. 25.
    Johansen VA, Wahl AK, Eilertsen DE, Weisaeth L (2007) Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. A longitudinal study. Soc Psychiatry Psychiatr Epidemiol 42:583–593CrossRefPubMedGoogle Scholar
  26. 26.
    Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol 67:1063–1078CrossRefPubMedGoogle Scholar
  27. 27.
    Schou I, Ekeberg O, Sandvik L, Ruland CM (2005) Stability in optimism–pessimism in relation to bad news: a study of women with breast cancer. J Pers Assess 84:148–154CrossRefPubMedGoogle Scholar
  28. 28.
    Jones C, Humphris G, Griffiths RD (2000) Preliminary validation of the ICUM tool: a tool for assessing memory of the intensive care experience. Clin Intensive Care 11:251–255CrossRefGoogle Scholar
  29. 29.
    Capuzzo M, Valpondi V, Cingolani E, De LS, Gianstefani G, Grassi L, Alvisi R (2004) Application of the Italian version of the Intensive Care Unit Memory tool in the clinical setting. Crit Care 8:R48–R55CrossRefPubMedGoogle Scholar
  30. 30.
    Kvale R, Ulvik A, Flaatten H (2003) Follow-up after intensive care: a single center study. Intensive Care Med 29:2149–2156CrossRefPubMedGoogle Scholar
  31. 31.
    Ringdal M, Plos K, Lundberg D, Johansson L, Bergbom I (2009) Outcome after injury: memories, health-related quality of life, anxiety, and symptoms of depression after intensive care. J Trauma 66:1226–1233CrossRefPubMedGoogle Scholar
  32. 32.
    Ringdal M, Johansson L, Lundberg D, Bergbom I (2006) Delusional memories from the intensive care unit—experienced by patients with physical trauma. Intensive Crit Care Nurs 22:346–354CrossRefPubMedGoogle Scholar
  33. 33.
    Skovlund E, Fenstad GU (2001) Should we always choose a nonparametric test when comparing two apparently nonnormal distributions? J Clin Epidemiol 54:86–92CrossRefPubMedGoogle Scholar
  34. 34.
    Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68:748–766CrossRefPubMedGoogle Scholar
  35. 35.
    Jin RL, Shah CP, Svoboda TJ (1995) The impact of unemployment on health: a review of the evidence. CMAJ 153:529–540PubMedGoogle Scholar
  36. 36.
    Capuzzo M, Pinamonti A, Cingolani E, Grassi L, Bianconi M, Contu P, Gritti G, Alvisi R (2001) Analgesia, sedation, and memory of intensive care. J Crit Care 16:83–89CrossRefPubMedGoogle Scholar
  37. 37.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1986) An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 104:410–418PubMedGoogle Scholar
  38. 38.
    Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, Im K, Donahoe M, Pinsky MR (2002) Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med 30:746–752CrossRefPubMedGoogle Scholar
  39. 39.
    Samuelson K, Lundberg D, Fridlund B (2006) Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients. Intensive Care Med 32:660–667CrossRefPubMedGoogle Scholar
  40. 40.
    Weinert CR, Sprenkle M (2008) Post-ICU consequences of patient wakefulness and sedative exposure during mechanical ventilation. Intensive Care Med 34:82–90CrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Hilde Myhren
    • 1
    Email author
  • Kirsti Tøien
    • 1
  • Øivind Ekeberg
    • 2
    • 4
  • Susanne Karlsson
    • 1
  • Leiv Sandvik
    • 3
  • Olav Stokland
    • 1
  1. 1.Intensive Care UnitOslo University HospitalOsloNorway
  2. 2.Department of Acute MedicineOslo University HospitalOsloNorway
  3. 3.Section of Epidemiology and BiostatisticsOslo University HospitalOsloNorway
  4. 4.Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway

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