Demographic, psychosocial, and medical correlates of psychological morbidity after intensive care unit stay
More details
Hide details
Department of Social and Clinical Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Intensive Care Unit (ICU) and Department of Pain Management & Palliative Care, Cancer Hospital Theagenio, Thessaloniki, Greece
Submission date: 2021-04-28
Final revision date: 2022-01-10
Acceptance date: 2022-01-16
Online publication date: 2022-02-21
Publication date: 2022-02-22
Health Psychology Report 2022;10(3):191–202
Psychological morbidity [post-traumatic stress disorder (PTSD) symptoms, depressive, and anxiety symptoms] and a decline in health-related quality of life (HRQoL) are common after treatment in an intensive care unit (ICU). The aims of this article are: (a) to report psychological morbidity and HRQoL status three months after the ICU stay; (b) to report psy-chological morbidity correlates [demographic factors, social constraint (SC) regarding the ICU experience, negative ICU-related memories (NIM), and medical factors]; (c) to examine the hypothesis that SC would be a predictor of psychological morbidity after the ICU stay.

Participants and procedure:
Seventy-two Greek patients filled in the following questionnaires: the Impact of Event Scale-Revised, the Hospital Anxiety and Depression Scale, the EuroQoL-5D-5L, and five questions regarding SC.

In total, 47% of participants had symptoms of psychological morbidity at a moderate to high level and 94% reported that they had at least a problem regarding HRQoL. Predictors of PTSD symptoms were NIM, SC, female gender, and haloperidol dose. Predictors of anxiety symptoms were SC, the reporting of another stressor after the ICU stay, and low income. Pre-dictors of depressive symptoms were SC, remifentanil dose (negative), and the reporting of another stressor.

Participants experienced elevated levels of psychological symptoms and SC emerged as a consistent predictor of psycho-logical morbidity three months after the ICU stay.

Abraham, C. M., Obremskey, W. T., Song, Y., Jackson, J. C., Ely, E. W., & Archer, K. R. (2014). Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage. Archives of Physical Medicine and Rehabilitation, 95, 2382–2389. https://doi.org/10.1016/j.apmr....
Asimakopoulou, E., & Madianos, M. (2014). Depression and post-traumatic stress disorder among patients in intensive care units. Psychiatriki, 25, 257–269.
Beinke, K. L., O’Callaghan, F. V., & Morrissey, S. (2015). The impact of social constraints and sense of coherence on the psychological adjustment of adolescents and young adults with CF. Cogent Psychology, 2, 1019237. https://doi.org/10.1080/233119....
Bieleninik, Ł., Konieczna-Nowak, L., Knapik-Szweda, S., & Kwaśniok, J. (2020). Music therapy for preterm infants and their parents during NICU stay and beyond: Current recommendations for clinical practice in Poland. Health Psychol-ogy Report, 8, 189–201. https://doi.org/10.5114/hpr.20....
Bienvenu, O. J., Gellar, J., Althouse, B. M., Colantuoni, E., Sricharoenchai, T., Mendez-Tellez, P. A., Shanholtz, C., Dennison, C. R., Pronovost, P. J., & Needham, D. M. (2013). Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychological Medicine, 43, 2657–2671. https://doi.org/10.1017/S00332....
Cohee, A. A., Adams, R. N., Fife, B. L., Von Ah, D. M., Monahan, P. O., Zoppi, K. A., Cella, D., & Champion, V. L. (2017). Rela-tionship between depressive symptoms and social cognitive processing in partners of long-term breast cancer survi-vors. Oncology Nursing Forum, 44, 44–51. https://doi.org/10.1188/17.ONF....
Cuthbertson, B. H., Roughton, S., Jenkinson, D., Maclennan, G., & Vale, L. (2010). Quality of life in the five years after intensive care: a cohort study. Critical Care, 14, R6. https://doi.org/10.1186/cc8848.
Davydow, D. S., Gifford, J. M., Desai, S. V., Needham, D. M., & Bienvenu, O. J. (2008). Posttraumatic stress disor-der in general intensive care unit survivors: a systematic review. General Hospital Psychiatry, 30, 421–434. https://doi.org/10.1016/j.genh....
Dowdy, D. W., Eid, M. P., Sedrakyan, A., Mendez-Tellez, P. A., Pronovost, P. J., Herridge, M. S., & Needham, D. M. (2005). Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Medicine, 31, 611–620. https://doi.org/10.1007/s00134....
Egerod, I., Christensen, D., Schwartz-Nielsen, K. H., & Ågård, A. S. (2011). Constructing the illness narrative: a grounded theory exploring patients’ and relatives’ use of intensive care diaries. Critical Care Medicine, 39, 1922–1928. https://doi.org/10.1097/CCM.0b....
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345. https://doi.org/10.1016/s0005-....
EuroQol Group (1990). EuroQoL – a new facility for the measurement of health-related quality of life. Health Poli-cy, 16, 199–208. https://doi.org/10.1016/0168-8....
Fildissis, G., Zidianakis, V., Tsigou, E., Koulenti, D., Katostaras, T., Economou, A., & Baltopoulos, G. (2007). Quality of life outcome of critical care survivors eighteen months after discharge from intensive care. Croatian Medi-cal Journal, 48, 814–821. https://doi.org/10.3325/cmj.20....
Garrouste-Orgeas, M., Coquet, I., Périer, A., Timsit, J. F., Pochard, F., Lancrin, F., Philippart, F., Vesin, A., Bruel, C., Blel, Y., Angeli, S., Cousin, N., Carlet, J., & Misset, B. (2012). Impact of an intensive care unit diary on psychological distress in patients and relatives. Critical Care Medicine, 40, 2033–2040. https://doi.org/10.1097/CCM.0b....
Hobfoll, S. E. (2002). Social and psychological resources and adaptation. Review of General Psychology, 6, 307–324. https://doi.org/10.1037/1089-2....
Hobfoll, S. E. (1989). Conservation of resources: a new attempt at conceptualizing stress. American Psychologist, 44, 513–524. https://doi.org/10.1037/0003-0....
Jackson, J. C., Jutte, J. E., Hunter, C. H., Ciccolella, N., Warrington, H., Sevin, C., & Bienvenu, O. J. (2016). Post-traumatic stress disorder (PTSD) after critical illness: a conceptual review of distinct clinical issues and their implications. Rehabilitation Psychology, 61, 132–140. https://doi.org/10.1037/rep000....
Kontodimopoulos, N., Pappa, E., Niakas, D., Yfantopoulos, J., Dimitrakaki, C., & Tountas, Y. (2008) Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value In Health, 11, 1162–1169.
Lepore, S. J. (2001). A social-cognitive processing model of emotional adjustment to cancer. In A. Baum & B. L. Andersen (Eds.), Psychosocial interventions for cancer (pp. 99–116). American Psychological Association.
Lepore, S. J., Silver, R. C., Wortman, C. B., & Wayment, H. A. (1996). Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. Journal of Personality and Social Psychology, 70, 271–282. https://doi.org/10.1037/002235....
McGiffin, J. N., Galatzer-Levy, I. R., & Bonanno, G. A. (2016). Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses. Rehabilitation Psychology, 61, 120–131. https://doi.org/10.1037/rep000....
Michopoulos, I., Douzenis, A., Kalkavoura, C., Christodoulou, C., Michalopoulou, P., Kalemi, G., Fineti, K., Patapis, P., Protopapas, K., & Lykouras, L. (2008). Hospital Anxiety and Depression Scale (HADS): Validation in a Greek general hospital sample. Annals of General Psychiatry, 7, 4. https://doi.org/10.1186/1744-8....
Mystakidou, K., Tsilika, E., Parpa, E., Galanos, A., & Vlahos, L. (2007). Psychometric properties of the Impact of Event Scale in Greek cancer patients. Journal of Pain and Symptom Management, 33, 454–461. https://doi.org/10.1016/j.jpai....
Nikayin, S., Rabiee, A., Hashem, M. D., Huang, M., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Anxi-ety symptoms in survivors of critical illness: a systematic review and meta-analysis. General Hospital Psychia-try, 43, 23–29. https://doi.org/10.1016/j.genh....
Olff, M. (2017). Sex and gender differences in post-traumatic stress disorder: an update. European Journal of Psy-chotraumatology, 8, 1351204. https://doi.org/10.1080/200081....
Parker, A. M., Sricharoenchai, T., Raparla, S., Schneck, K. W., Bienvenu, O. J., & Needham, D. M. (2015). Posttrau-matic stress disorder in critical illness survivors: a meta-analysis. Critical Care Medicine, 43, 1121–1129. https://doi.org/10.1097/CCM.00....
Rabiee, A., Nikayin, S., Hashem, M. D., Huang, M., Dinglas, V. D., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Depressive symptoms after critical illness: a systematic review and meta-analysis. Critical Care, 44, 1744–1753. https://doi.org/10.1097/CCM.00....
Righy, C., Rosa, R. G., da Silva, R., Kochhann, R., Migliavaca, C. B., Robinson, C. C., Teche, S. P., Teixeira, C., Bozza, F. A., & Falavigna, M. (2019). Prevalence of post-traumatic stress disorder symptoms in adult critical care sur-vivors: a systematic review and meta-analysis. Critical Care, 23, 213. https://doi.org/10.1186/s13054....
Rimé, B. (1995). Mental rumination, social sharing, and the recovery from emotional exposure. In J. W. Pennebaker (Ed.), Emotion, disclosure, & health (pp. 271–291). American Psychological Association.
Rini, C., & Schetter, C. D. (2010). The effectiveness of social support attempts in intimate relationships. In K. T. Sullivan & J. Davila (Eds.), Support processes in intimate relationships (pp. 26–67). Oxford University Press.
Samuelson, K. A., Lundberg, D., & Fridlund, B. (2007). Stressful memories and psychological distress in adult me-chanically ventilated intensive care patients - a 2-month follow-up study. Acta Anaesthesiologica Scandinavi-ca, 51, 671–678. https://doi.org/10.1111/j.1399....
Schandl, A., Bottai, M., Hellgren, E., Sundin, O., & Sackey, P. V. (2013). Developing an early screening instrument for predicting psychological morbidity after critical illness. Critical Care, 17, R210. https://doi.org/10.1186/cc1301....
Stoll, C., Kapfhammer, H. P., Rothenhäusler, H. B., Haller, M., Briegel, J., Schmidt, M., Krauseneck, T., Durst, K., & Schelling, G. (1999). Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Medicine, 25, 697–704. https://doi.org/10.1007/s00134....
Wade, D. M., Hankins, M., Smyth, D. A., Rhone, E. E., Mythen, M. G., Howell, D. C., & Weinman, J. A. (2014). De-tecting acute distress and risk of future psychological morbidity in critically ill patients: Validation of the inten-sive care psychological assessment tool. Critical Care, 18, 519. https://doi.org/10.1186/s13054....
Wade, D., Hardy, R., Howell, D., & Mythen, M. (2013). Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiologica, 79, 944–963.
Wade, D. M., Howell, D. C., Weinman, J. A., Hardy, R. J., Mythen, M. G., Brewin, C. R., Borja-Boluda, S., Matejowsky, C. F., & Raine, R. A. (2012). Investigating risk factors for psychological morbidity three months af-ter intensive care: a prospective cohort study. Critical Care, 16, R192. https://doi.org/10.1186/cc1167....
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), As-sessing psychological trauma and PTSD: a practitioner’s handbook (pp. 399–411). Guilford Press.
Wintermann, G. B., Rosendahl, J., Weidner, K., Strauß, B., & Petrowski, K. (2018). Predictors of major depressive disorder following intensive care of chronically critically ill patients. Critical Care Research and Practice, 2018, 1586736. https://doi.org/10.1155/2018/1....
Widows, M. R., Jacobsen, P. B., & Fields, K. K. (2000). Relation of psychological vulnerability factors to posttrau-matic stress disorder symptomatology in bone marrow transplant recipients. Psychosomatic Medicine, 62, 873–882. https://doi.org/10.1097/000068....
Yfantopoulos, J. (2001). The Greek version of the EuroQoL (EQ-5D) instrument. Archives of Hellenic Medicine, 8, 180–191.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600....