Assessment and prediction of long term psychological outcome after intensive care

Abstract

The aim of this research has been the examination of the long term psychological consequences of admission to the Intensive Care Unit (ICU) for critical illness. The major objectives were first, psychometric assessment at specified intervals post-discharge, using the General Health Questionnaire, Rosenberg Self Esteem scale, and the Impact of Event Scale, and secondly identification of ICU related variables which influence psychological wellbeing and recovery. The design was prospective and used survey methods. Seventy-two patients were recruited from the ICU at St James's University Hospital in Leeds. Data were collected at six weeks, six months and twelve months post-discharge. The initial analysis produced evidence of discrimination between subgroups, in particular age, length of stay in ICU, admission severity, indication for admission, communication, pre-existence of cancer, and the use of muscle relaxant drugs. Further analysis by way of a logistic regression identified four factors which may have predictive properties - age, admission severity, trauma and pre-existence of cancer. Patients from younger age groups reported more post traumatic stress symptoms than older patients; patients with pre-existing cancer also reported fewer post traumatic stress symptoms. Patients admitted following trauma reported poorer psychological outcome. Admission severity was negatively associated with psychological dysfunction, with those who were sickest on admission reporting fewer problems. Symptoms of post traumatic stress disorder were found in a number of patients; at final follow-up 27% of the surviving sample had medium levels, and 27% high levels of post traumatic stress symptoms. ICU patients form a fragile group to study and sample attrition was considerable. Nevertheless the findings are of interest to this developing research area and suggestions are made regarding their utilisation