Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.
Abstract
Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision
makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized
into clusters including intrusion, avoidance, and hyperarousal, each of which has
been associated with distinct outcomes and treatment responses. Our objective was
to determine which symptom cluster was predominant among surrogates of patients with
CCI.<h4>Design</h4>Secondary analysis of data from a clinical trial of a communication
intervention.<h4>Setting</h4>The original trial was conducted in medical intensive
care units at three tertiary-care centers and one community hospital.<h4>Patients</h4>Patients
with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from
the ventilator in the subsequent 72 hr) and their surrogates.<h4>Interventions</h4>None.<h4>Measurements
and main results</h4>Surrogate PTSD symptoms were measured 90 days after onset of
patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a
total score (range, 0-88, higher scores indicate severe symptoms) as well as three
subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and
avoidance scores 0-32 and range of hyperarousal score 0-24). Intrusion symptoms were
most severe (mean score, 10.3; 95% CI, 9.3-11.2), followed by avoidance (mean score,
8.0; 95% CI, 7.2-8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI,
4.5-5.7). In a multivariable linear regression model, we found that surrogates of
patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; <i>p</i> = 0.001) symptoms than surrogates of patients
who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient
death was not associated with hyperarousal symptoms.<h4>Conclusions</h4>Intrusive
thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI,
with intensified symptoms among surrogates of patients who died. These results have
the potential to inform tailored treatment strategies to reduce PTSD symptoms in this
population.
Type
Journal articleSubject
chronic critical illnessfamily caregiver
posttraumatic stress disorder
posttraumatic stress disorder symptom clusters
surrogate decision maker
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https://hdl.handle.net/10161/24750Published Version (Please cite this version)
10.1097/cce.0000000000000647Publication Info
Wendlandt, Blair; Ceppe, Agathe; Gaynes, Bradley N; Cox, Christopher E; Hanson, Laura
C; Nelson, Judith E; & Carson, Shannon S (2022). Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients
Experiencing Chronic Critical Illness. Critical care explorations, 4(3). pp. e0647. 10.1097/cce.0000000000000647. Retrieved from https://hdl.handle.net/10161/24750.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Christopher Ethan Cox
Professor of Medicine
My work is conducted as a clinician, researcher, teacher, and administrator at Duke
University. Currently, I am an Associate Professor of Medicine, the director of Duke’s
Medical Intensive Care Unit (MICU), and the Director of the Duke Program to Support
People and Enhance Recovery (ProSPER). My clinical work is based in ICUs at Duke
University, though I am also a board-certified palliative medicine specialist.My research
focuses on understanding and improving the e

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