Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters

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Abstract

Background

Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking.

Methods

The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.

Results

Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients.

Conclusions

Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment.

Trial registration

German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2321-0) contains supplementary material, which is available to authorized users.

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Most cited references 36

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Risk of post-traumatic stress symptoms in family members of intensive care unit patients.

Elie Azoulay, Frédéric Pochard, Nancy Kentish-Barnes … (2005)

Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD). Factors associated with these symptoms need to be identified. For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role. Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of post-traumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey during a telephone interview. Linear regression was used to identify factors associated with the risk of post-traumatic stress symptoms. Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life. Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.

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Long-term mortality and quality of life in sepsis: a systematic review.

Bradford D Winters, Michael Eberlein, Janice Leung … (2010)

Long-term outcomes from sepsis are poorly understood, and sepsis in patients may have different long-term effects on mortality and quality of life. Long-term outcome studies of other critical illnesses such as acute lung injury have demonstrated incremental health effects that persist after hospital discharge. Whether patients with sepsis have similar long-term mortality and quality-of-life effects is unclear. We performed a systematic review of studies reporting long-term mortality and quality-of-life data (>3 months) in patients with sepsis, severe sepsis, and septic shock using defined search criteria. Systematic review of the literature. None. Patients with sepsis showed ongoing mortality up to 2 yrs and beyond after the standard 28-day inhospital mortality end point. Patients with sepsis also had decrements in quality-of-life measures after hospital discharge. Results were consistent across varying severity of illness and different patient populations in different countries, including large and small studies. In addition, these results were consistent within observational and randomized, controlled trials. Study quality was limited by inadequate control groups and poor adjustment for confounding variables. Patients with sepsis have ongoing mortality beyond short-term end points, and survivors consistently demonstrate impaired quality of life. The use of 28-day mortality as an end point for clinical studies may lead to inaccurate inferences. Both observational and interventional future studies should include longer-term end points to better-understand the natural history of sepsis and the effect of interventions on patient morbidities.

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A developmental-contextual model of couples coping with chronic illness across the adult life span.

Lise Berg, Renn Upchurch (2007)

A developmental-contextual model of couples coping with chronic illness is presented that views chronic illness as affecting the adjustment of both the patient and the spouse such that coping strategies enacted by the patient are examined in relation to those enacted by the spouse, and vice versa. The developmental model emphasizes that dyadic coping may be different at various phases of the life span, changing temporally at different stages of dealing with the illness as well as unfolding daily as spouses interact around dyadic stressors. In addition, couples engaged in dyadic coping are affected by broad sociocultural factors (culture and gender) as well as more proximal contextual factors (quality of the marital relationship and the specific demands of the chronic illness). The model provides a framework for understanding how couples coping with chronic illness may together appraise and cope with illness during adulthood and for determining when spousal involvement is beneficial or harmful to both patient and spousal adjustment. The developmental-contextual model to dyadic appraisal and coping has numerous research implications for the field, and the authors conclude with specific recommendations for future research.

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Author and article information

Contributors

Gloria-Beatrice Wintermann:

ORCID: http://orcid.org/0000-0002-6292-0852

+49 351 458 4707 , gloria.wintermann@uniklinikum-dresden.de

Katja Petrowski: Katja.Petrowski@tu-dresden.de

Kerstin Weidner: Kerstin.Weidner@uniklinikum-dresden.de

Bernhard Strauß: Bernhard.Strauss@med.uni-jena.de

Jenny Rosendahl: Jenny.Rosendahl@med.uni-jena.de

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 8 February 2019

Publication date PMC-release: 8 February 2019

Publication date Collection: 2019

Volume: 23

Electronic Location Identifier: 39

Affiliations

[1 ]ISNI 0000 0001 2111 7257, GRID grid.4488.0, Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, , Technische Universität Dresden, ; 01307 Dresden, Germany

[2 ]GRID grid.410607.4, Institute of Medical Psychology and Medical Sociology, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, , University Medical Center of the Johannes Gutenberg University, ; Mainz, Germany

[3 ]Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany

[4 ]Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany

Author information

Gloria-Beatrice Wintermann http://orcid.org/0000-0002-6292-0852

Article

Publisher ID: 2321

DOI: 10.1186/s13054-019-2321-0

PMC ID: 6368748

PubMed ID: 30736830

SO-VID: 8c0e408a-bcbd-423d-b27d-51976f6f7bab

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 10 August 2018

Date accepted : 11 January 2019

Funding

Funded by: This study was supported by the German Federal Ministry of Education and Research grant.

Award ID: 01EO1002

Award Recipient : Jenny Rosendahl

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: chronic critical illness,intensive care unit (icu),post-traumatic stress symptoms,sepsis,partners,post-intensive care syndrome-family (pics-f),actor-partner-interdependence model (apim),health-related quality of life (qol)

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: chronic critical illness, intensive care unit (icu), post-traumatic stress symptoms, sepsis, partners, post-intensive care syndrome-family (pics-f), actor-partner-interdependence model (apim), health-related quality of life (qol)

Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters

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Irish Journal of Paramedicine

Most cited references 36

Risk of post-traumatic stress symptoms in family members of intensive care unit patients.

Long-term mortality and quality of life in sepsis: a systematic review.

A developmental-contextual model of couples coping with chronic illness across the adult life span.

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