Causes of PTSD – Intensive Care Patients

The long-term psychological impact of critical illness has received a lot of attention in recent years. Critical illness that requires treatment in an intensive care unit (ICU) exposes a patient to extreme stressors. These include:

• Painful procedures
• Numerous medications
• Mechanical ventilation
• Inability to communicate

Studies have indicated that most patients in ICU experience an episode of delirium. This is characterised by disturbance of consciousness and inability to focus attention. These disturbing experiences of delirium, coupled with the extreme stressors listed above, can frequently cause survivors of the ICU to develop symptoms of post-traumatic stress disorder (PTSD) after leaving.

Why does intensive care cause PTSD?

You only get admitted to intensive care if you are in danger of dying. You need to be monitored 24 hours a day and often require multiple invasive medical procedures to keep you alive. You may be connected to various machines like mechanical ventilators and heart monitors, which make lots of noises to alert medical personnel of your condition. There may also be tubes pumping fluids into you and/or taking other fluids out.

In the ICU, you are often sedated but still conscious. Your arms or legs might be restrained to prevent you from removing tubes or making movements that might exacerbate your injuries. Though all of these interventions are necessary to help you survive the critical illness, they can be incredibly frightening. This prolonged fear and the experience of not having control of your own body can be extremely traumatic, and that can take a toll on your mind.

Signs of PTSD

Symptoms of the condition have been well-described, though it could present slightly differently for ICU survivors. The symptoms to look out for include:

• Upsetting and persistent memories of the critical illness
• Extreme anxiety triggered by reminders of the critical illness
• Nightmares
• Fear of hospitals and healthcare providers
• Emotional withdrawal and disengagement
• A sense of foreboding about the future

How common is PTSD among ICU survivors?

It is normal to experience some symptoms of PTSD after suffering trauma. For most people, these symptoms start to fade after a month or so. However, around 20-30% of people find their symptoms persist for longer than this. As such, it is estimated that PTSD after treatment in intensive care affects about 1 in 5 people.

Are some people more likely to get PTSD than others?

Two different people exposed to similar traumatic stressors can have very different reactions. In most cases, they will not go on to develop PTSD. However, it is thought that some people are more vulnerable than others to developing PTSD after a stay in the ICU.

According to a study by academics from University College London and Kings College London, the risk factors for post-ICU PTSD include socio-demographic factors (age, sex and unemployment), psychological history (depression, anxiety) and the individual’s experience of the ICU.

In other words, your risk of developing PTSD as a result of a traumatic ICU experience is higher if you:

• Are young in age
• Are female
• Have a background of traumatic experiences
• Have a pre-existing mental health concern
• Experience extreme stressors and/or prolonged delirium in the ICU

What should I do if I think I may have post-ICU PTSD?

If you find that you are experiencing symptoms that could be related to PTSD, it’s time to look to a professional for help. Your GP can refer you to your local authority’s mental health services or provide you with contact details to get an assessment.

Once you have an appointment to be assessed, it’s important to be honest about how you are feeling. Mental health concerns are very common and many are highly treatable. No-one has to suffer in silence and, as the saying goes, it’s okay to not be okay.

PTSD UK is a charity run by volunteers to help provide information for sufferers of PTSD at every stage of their journey. If you would like to learn more before contacting your GP, we encourage you to explore our articles and learn more about what you are going through.

References:  V. J. Page, S. Navarange, S. Gama, and D. F. McAuley, “Routine delirium monitoring in a UK critical care unit,” Critical Care, vol. 13, no. 1, article R16, 2009, ICU Delerium, BiomedCentral, Psychology Tools, NHS, Clinical Partners