Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.

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dc.contributor.author

Wendlandt, Blair

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Ceppe, Agathe

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Gaynes, Bradley N

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Cox, Christopher E

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Hanson, Laura C

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Nelson, Judith E

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Carson, Shannon S

dc.date.accessioned

2022-04-01T13:31:44Z

dc.date.available

2022-04-01T13:31:44Z

dc.date.issued

2022-03

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2022-04-01T13:31:43Z

dc.description.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.

Design

Secondary analysis of data from a clinical trial of a communication intervention.

Setting

The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital.

Patients

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.

Interventions

None.

Measurements and main results

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; p = 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.

Conclusions

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.

dc.identifier.issn

2639-8028

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2639-8028

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https://hdl.handle.net/10161/24750

dc.language

eng

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Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Critical care explorations

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10.1097/cce.0000000000000647

dc.subject

chronic critical illness

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family caregiver

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posttraumatic stress disorder

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posttraumatic stress disorder symptom clusters

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surrogate decision maker

dc.title

Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.

dc.type

Journal article

duke.contributor.orcid

Cox, Christopher E|0000-0002-4486-0681

pubs.begin-page

e0647

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3

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Medicine

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Medicine, Pulmonary, Allergy, and Critical Care Medicine

pubs.publication-status

Published

pubs.volume

4

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