Psychological sequelae following ICU admission at a level 1 academic South African hospital

Abstract

Purpose. The purpose of this research was to determine the extent to which anxiety symptoms, depressive symptoms and post-traumatic stress (PTS) symptoms were experienced by a sample of patients after discharge from intensive care units (ICUs). The participants had a mean stay of 3 days in ICUs in a level 1 academic hospital in Gauteng, South Africa.

Methods. A prospective, quantitative, cross-sectional, descriptive design was used to investigate these variables. A preliminary record review of the hospital’s ICU bed occupancy for the previous year was 1 596. The total study sample was 98 (N=98) to ensure that a power of at least 95% accuracy was acquired for the 0.05 level of significance testing. The instruments used in the structured interview were the Hospital Anxiety and Depression Scale (HADS) developed by Zigmond and Snaith (1983) and the Experience after Treatment in Intensive Care 7-Item Scale (ETIC-7) developed by Scragg, Jones and Fauvel (2001). Data were analysed using STATA 10.

Findings. Just under half the sample population (48%) had symptoms of anxiety, more than a quarter had symptoms of depression (28%), and 32% had symptoms of PTS. Furthermore, it was elicited that 58% of the sample had combined anxiety and depressive symptoms severe enough to have a ‘possible clinical disorder’. An unexpected finding of this study was that patients who had memory of physical restraints in the ICU were six times more likely to develop symptoms of PTS than those with no memory of physical restraint.

Conclusions. It was observed in this study that a significant number of ICU patients returning to the community develop psychological sequelae related to their admission and the treatments necessary, e.g. mechanical ventilation. This psychological distress can affect patients’ physical recovery (by an altered and decreased immune function), their quality of life and their functioning in the family and in society.

Clinical relevance. The prevalence of psychological sequelae after treatment in an ICU was found to be high. At present ICU staff in South Africa have limited evidence on which to base decisions about improvements to critical care practice and the psychological sequelae following treatments in an ICU. Critical illness and the recovery from it do not end at the ICU door, and patients should be identified, followed up and offered the necessary support.