Processing Intensive Care Unit Treatment Experiences: A Thematic Analysis of a Diary Intervention.

Survivors of the intensive care unit (ICU) report an aggregate of burdensome memories. ICU diaries have been proposed to address the psychological impact of ICU treatment. Twenty-six participants wrote about their ICU experiences in three successive sessions, while in the second session, they were presented with a dairy derived from their medical records. Using inductive thematic analysis in the first and third narratives, we explore how participants initially describe their ICU experience and how they process it after the intervention. Participants described a martyrdom experience, including being emotionally distressed, disorientated, and physically trapped that provoked a quest for any available interpersonal support. A vacuum-like state permeated their existence, impacted their sense-making ability, and the proximity to death uniquely characterized this experience. After intervention, participants made small but significant changes in their written narratives. They appeared to reorganize their recollections, reestablish self-continuity by integrating their ICU experiences, and authored restitution narratives.

Demographic, psychosocial, and medical correlates ofpsychological morbidity after intensive care unit stay.

BACKGROUND: Psychological morbidity [post-traumatic stress disorder (PTSD) symptoms, depressive, and anxiety symptoms] and a decline in health-related quality of life (HRQoL) are common after treatment in an intensive care unit (ICU). The aims of this article are: (a) to report psychological morbidity and HRQoL status three months after the ICU stay; (b) to report psychological morbidity correlates [demographic factors, social constraint (SC) regarding the ICU experience, negative ICU-related memories (NIM), and medical factors]; (c) to examine the hypothesis that SC would be a predictor of psychological morbidity after the ICU stay. PARTICIPANTS AND PROCEDURE: Seventy-two Greek patients filled in the following questionnaires: the Impact of Event Scale-Revised, the Hospital Anxiety and Depression Scale, the EuroQoL-5D-5L, and five questions regarding SC. RESULTS: In total, 47% of participants had symptoms of psychological morbidity at a moderate to high level and 94% reported that they had at least a problem regarding HRQoL. Predictors of PTSD symptoms were NIM, SC, female gender, and haloperidol dose. Predictors of anxiety symptoms were SC, the reporting of another stressor after the ICU stay, and low income. Predictors of depressive symptoms were SC, remifentanil dose (negative), and the reporting of another stressor. CONCLUSIONS: Participants experienced elevated levels of psychological symptoms and SC emerged as a consistent predictor of psychological morbidity three months after the ICU stay.

Psychological morbidity a year after treatment in intensive care unit.

Several studies have linked treatment in the Intensive Care Unit (ICU) with negative psychological outcomes. This study explores the prevalence of negative psychological outcomes in Greek patients (N=29), a year after treatment in ICU. Percentages of participants with anxiety [41%, 95% CI (22%, 60%)] and Post- Traumatic Stress Disorder (PTSD) [34%, 95% CI (16%, 53%)] symptoms were similar to the related literature. Percentages of participants with depressive [17%, 95% CI (3%, 32%)] symptoms were rather low. Only 10% of participants reported absence of quality of live issues. Anxiety symptoms were related to desire to talk about the ICU experience (p=0.010), duration of propofol administration (p=0.018) and loss of employment (p=0.019) and negatively related to duration of stay in the ICU (p=0.025). PTSD symptoms were related to experiencing other stressors during the year after the ICU stay (p=0.001), social constraint (p=0.003), duration of propofol administration (p=0.004), loss of employment (p=0.020), low income (p=0.022) and negative ICU memories (p=0.029). Depressive symptoms were related to loss of employment (p=0.003), low income (p=0.029) and social constraint (p=0.033). Patients experience elevated levels of psychological symptoms long after they are discharged from the hospital. Several psychosocial factors emerged as important factors to consider for predicting levels of distress.