Post-Traumatic Stress Disorder in Survivors of Critical Illness

  • Jennifer H. Ryu
  • Maia S. Kredentser
  • O. Joseph Bienvenu
  • Marcus Blouw
  • Jitender Sareen
  • Kendiss OlafsonEmail author
Reference work entry


The intensive care unit (ICU) experience is traumatic for patients and their families and can have lasting psychological effects. This chapter reviews PTSD in critical illness survivors and their families and provides current data and evidence on its prevalence, presentation, and risk factors. Challenges that are unique to the ICU patient population are discussed, and an overview of potential strategies to prevent and treat PTSD in the setting of ICU is provided.


Intensive care Critically ill Post-traumatic stress disorder Post-intensive care syndrome 

List of Abbreviations


Acute respiratory distress syndrome


Acute stress disorder


End of life


Intensive care unit


Impacts of events scale-revised


Post-intensive care syndrome


Post-traumatic stress disorder


  1. Anderson WG, Arnold RM, Angus DC, et al. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med. 2008;23(11):1871–6.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Angus DC, Kelley MA, Schmitz RJ, et al. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70.PubMedCrossRefGoogle Scholar
  3. Azoulay E, Pochard F, Chevret S, et al. Meeting the needs of intensive care unit patient families: a multicenter study. Am J Respir Crit Care Med. 2001;163(1):135–9.PubMedCrossRefGoogle Scholar
  4. Azoulay E, Pochard F, Chevret S, et al. Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med. 2002;165(4):438–42.PubMedCrossRefGoogle Scholar
  5. Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171(9):987–94.PubMedCrossRefGoogle Scholar
  6. Backman CG, Walther SM. Use of a personal diary written on the ICU during critical illness. Intensive Care Med. 2001;27(2):426–9.PubMedCrossRefGoogle Scholar
  7. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.PubMedCrossRefGoogle Scholar
  8. Bienvenu OJ, Gellar J, Althouse BM, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med. 2013a;43(12):2657–71.PubMedCrossRefGoogle Scholar
  9. Bienvenu OJ, Williams JB, Yang A, et al. Posttraumatic stress disorder in survivors of acute lung injury: evaluating the impact of event scale-revised. Chest. 2013b;144(1):24–31.PubMedPubMedCentralCrossRefGoogle Scholar
  10. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66.PubMedCrossRefGoogle Scholar
  11. Cuthbertson BH, Hull A, Strachan M, et al. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med. 2004;30(3):450–5.PubMedCrossRefGoogle Scholar
  12. Cuthbertson BH, Rattray J, Campbell MK, et al. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Dasta JF, Fuhrman TM, McCandles C. Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit. Crit Care Med. 1994;22(6):974–80.PubMedCrossRefGoogle Scholar
  14. Davidson JE, Daly BJ, Agan D, et al. Facilitated sensemaking: a feasibility study for the provision of a family support program in the intensive care unit. Crit Care Nurs Q. 2010;33(2):177–89.PubMedCrossRefGoogle Scholar
  15. Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med. 2012;40(2):618–24.PubMedCrossRefGoogle Scholar
  16. Davydow DS, Gifford JM, Desai SV, et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30(5):421–34.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Davydow DS, Gifford JM, Desai SV, et al. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med. 2009;35(5):796–809.PubMedCrossRefGoogle Scholar
  18. Davydow DS, Zatzick D, Hough CL, et al. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission. Gen Hosp Psychiatry. 2013;35(3):226–32.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Douglas SL, Daly BJ, Kelley CG, et al. Impact of a disease management program upon caregivers of chronically critically ill patients. Chest. 2005;128(6):3925–36.PubMedCrossRefGoogle Scholar
  20. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.PubMedCrossRefGoogle Scholar
  21. Engstrom A, Andersson S, Soderberg S. Re-visiting the ICU experiences of follow-up visits to an ICU after discharge: a qualitative study. Intensive Crit Care Nurs. 2008;24(4):233–41.PubMedCrossRefGoogle Scholar
  22. Ferrand E, Robert R, Ingrand P, et al. Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. Lancet. 2001;357(9249):9–14.PubMedCrossRefGoogle Scholar
  23. Fraser GL, Prato BS, Riker RR, et al. Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU. Pharmacotherapy. 2000;20(1):75–82.PubMedCrossRefGoogle Scholar
  24. Garrouste-Orgeas M, Coquet I, Perier A, et al. Impact of an intensive care unit diary on psychological distress in patients and relatives*. Crit Care Med. 2012;40(7):2033–40.PubMedCrossRefGoogle Scholar
  25. Giannini A, Garrouste-Orgeas M, Latour JM. What’s new in ICU visiting policies: can we continue to keep the doors closed? Intensive Care Med. 2014;40(5):730–3.PubMedCrossRefGoogle Scholar
  26. Girard TD, Shintani AK, Jackson JC, et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R28.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Gries CJ, Engelberg RA, Kross EK, et al. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest. 2010;137(2):280–7.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Griffiths JA, Barber VS, Cuthbertson BH, et al. A national survey of intensive care follow-up clinics. Anaesthesia. 2006;61(10):950–5.PubMedCrossRefGoogle Scholar
  29. Halpern NA, Pastores SM. Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65–71.PubMedCrossRefGoogle Scholar
  30. Hauer D, Weis F, Krauseneck T, et al. Traumatic memories, post-traumatic stress disorder and serum cortisol levels in long-term survivors of the acute respiratory distress syndrome. Brain Res. 2009;1293:114–20.PubMedCrossRefGoogle Scholar
  31. Hauer D, Weis F, Papassotiropoulos A, et al. Relationship of a common polymorphism of the glucocorticoid receptor gene to traumatic memories and posttraumatic stress disorder in patients after intensive care therapy. Crit Care Med. 2011;39(4):643–50.PubMedCrossRefGoogle Scholar
  32. Herridge MS, Tansey CM, Matte A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.PubMedCrossRefGoogle Scholar
  33. Hopkins RO, Girard TD. Medical and economic implications of cognitive and psychiatric disability of survivorship. Semin Respir Crit Care Med. 2012;33(4):348–56.PubMedCrossRefGoogle Scholar
  34. Hopkins RO, Weaver LK, Chan KJ, et al. Quality of life, emotional, and cognitive function following acute respiratory distress syndrome. J Int Neuropsychol Soc. 2004;10(7):1005–17.PubMedGoogle Scholar
  35. Hopkins RO, Weaver LK, Collingridge D, et al. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171(4):340–7.PubMedCrossRefGoogle Scholar
  36. Jabre P, Tazarourte K, Azoulay E, et al. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med. 2014;40(7):981–7.PubMedCrossRefGoogle Scholar
  37. Jastremski CA. ICU bedside environment: a nursing perspective. Crit Care Clin. 2000;16(4):723–34.PubMedCrossRefGoogle Scholar
  38. Jezierska N. Psychological reactions in family members of patients hospitalised in intensive care units. Anaesthesiol Intensive Ther. 2014;46(1):42–5.PubMedCrossRefGoogle Scholar
  39. Jones C, Griffiths RD, Humphris G, et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001;29(3):573–80.PubMedCrossRefGoogle Scholar
  40. Jones C, Skirrow P, Griffiths RD, et al. Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med. 2003;31(10):2456–61.PubMedCrossRefGoogle Scholar
  41. Jones C, Skirrow P, Griffiths RD, et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med. 2004;30(3):456–60.PubMedCrossRefGoogle Scholar
  42. Jones C, Backman C, Capuzzo M, et al. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007;33(6):978–85.PubMedCrossRefGoogle Scholar
  43. Jones C, Backman C, Capuzzo M, et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care. 2010;14(5):R168.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Jones C, Backman C, Griffiths RD. Intensive care diaries and relatives’ symptoms of posttraumatic stress disorder after critical illness: a pilot study. Am J Crit Care. 2012;21(3):172–6.PubMedCrossRefGoogle Scholar
  45. Kentish-Barnes N, Lemiale V, Chaize M, et al. Assessing burden in families of critical care patients. Crit Care Med. 2009;37(10 Suppl):S448–56.PubMedCrossRefGoogle Scholar
  46. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;370(17):1626–35.PubMedCrossRefGoogle Scholar
  47. Kress JP, Gehlbach B, Lacy M, et al. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168(12):1457–61.PubMedCrossRefGoogle Scholar
  48. Kross EK, Engelberg RA, Gries CJ, et al. ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU. Chest. 2011;139(4):795–801.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.PubMedCrossRefGoogle Scholar
  50. Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin Crit Care. 2011;17(1):43–9.PubMedCrossRefGoogle Scholar
  51. Myhren H, Ekeberg O, Stokland O. Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med. 2010a;38(7):1554–61.PubMedCrossRefGoogle Scholar
  52. Myhren H, Ekeberg O, Toien K, et al. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010b;14(1):R14.PubMedPubMedCentralCrossRefGoogle Scholar
  53. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–9.PubMedCrossRefGoogle Scholar
  54. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33(1):66–73.PubMedCrossRefGoogle Scholar
  55. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644–53.PubMedCrossRefGoogle Scholar
  56. Peris A, Bonizzoli M, Iozzelli D, et al. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care. 2011;15(1):R41.PubMedPubMedCentralCrossRefGoogle Scholar
  57. Raison CL, Miller AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160(9):1554–65.PubMedCrossRefGoogle Scholar
  58. Rattray J. Life after critical illness: an overview. J Clin Nurs. 2014;23(5–6):623–33.PubMedCrossRefGoogle Scholar
  59. Rattray JE, Hull AM. Emotional outcome after intensive care: literature review. J Adv Nurs. 2008;64(1):2–13.PubMedCrossRefGoogle Scholar
  60. Rotondi AJ, Chelluri L, Sirio C, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30(4):746–52.PubMedCrossRefGoogle Scholar
  61. Rundshagen I, Schnabel K, Wegner C, et al. Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care. Intensive Care Med. 2002;28(1):38–43.PubMedCrossRefGoogle Scholar
  62. Samuelson KA, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients – a 2-month follow-up study. Acta Anaesthesiol Scand. 2007;51(6):671–8.PubMedCrossRefGoogle Scholar
  63. Sareen J, Erickson J, Medved MI, et al. Risk factors for post-injury mental health problems. Depress Anxiety. 2013;30(4):321–7.PubMedCrossRefGoogle Scholar
  64. Schelling G, Stoll C, Kapfhammer HP, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med. 1999;27(12):2678–83.PubMedCrossRefGoogle Scholar
  65. Schelling G, Briegel J, Roozendaal B, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001;50(12):978–85.PubMedCrossRefGoogle Scholar
  66. Schelling G, Kilger E, Roozendaal B, et al. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry. 2004;55(6):627–33.PubMedCrossRefGoogle Scholar
  67. Schmidt M, Azoulay E. Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care. 2012;18(5):540–7.PubMedCrossRefGoogle Scholar
  68. Scragg P, Jones A, Fauvel N. Psychological problems following ICU treatment. Anaesthesia. 2001;56(1):9–14.PubMedCrossRefGoogle Scholar
  69. Siegel MD, Hayes E, Vanderwerker LC, et al. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med. 2008;36(6):1722–8.PubMedCrossRefGoogle Scholar
  70. Slota M, Shearn D, Potersnak K, et al. Perspectives on family-centered, flexible visitation in the intensive care unit setting. Crit Care Med. 2003;31(5 Suppl):S362–6.PubMedCrossRefGoogle Scholar
  71. So HM, Chan DSK. Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud. 2004;41(1):77–84.PubMedCrossRefGoogle Scholar
  72. Sundararajan K, Martin M, Rajagopala S, et al. Posttraumatic stress disorder in close relatives of intensive care unit patients’ evaluation (PRICE) study. Aust Crit Care. 2014;27:183–7.PubMedCrossRefGoogle Scholar
  73. Svenningsen H. Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit. Dan Med J. 2013;60(4):B4630.PubMedGoogle Scholar
  74. Wade DM, Howell DC, Weinman JA, et al. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Crit Care. 2012;16(5):R192.PubMedPubMedCentralCrossRefGoogle Scholar
  75. Wade D, Hardy R, Howell D, et al. Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol. 2013;79(8):944–63.PubMedGoogle Scholar
  76. Weinert CR, Gross CR, Kangas JR, et al. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med. 1997;156(4 Pt 1):1120–8.PubMedCrossRefGoogle Scholar
  77. Zatzick D, Jurkovich G, Rivara FP, et al. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg. 2013;257(3):390–9.PubMedPubMedCentralCrossRefGoogle Scholar
  78. Zimmerli M, Tisljar K, Balestra GM, et al. Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients. Resuscitation. 2014;85(6):801–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jennifer H. Ryu
    • 2
  • Maia S. Kredentser
    • 3
  • O. Joseph Bienvenu
    • 4
  • Marcus Blouw
    • 5
  • Jitender Sareen
    • 6
  • Kendiss Olafson
    • 1
    Email author
  1. 1.Section of Critical Care, Department of MedicineUniversity of ManitobaWinnipegCanada
  2. 2.Faculty of MedicineUniversity of ManitobaWinnipegCanada
  3. 3.Clinical Psychology, Department of PsychologyUniversity of ManitobaWinnipegCanada
  4. 4.Department of Psychiatry and Behavioral SciencesJohns Hopkins University, School of MedicineBaltimoreUSA
  5. 5.Sections of Respiratory and Critical Care Medicine, Department of MedicineUniversity of ManitobaWinnipegCanada
  6. 6.Department of PsychiatryUniversity of ManitobaWinnipegCanada

Personalised recommendations