by Cássia Righy, Regis Goulart Rosa, Rodrigo Teixeira
Amancio da Silva, Renata Kochhann, Celina Borges Migliavaca, Caroline Cabral
Robinson, Stefania Pigatto Teche, Cassiano Teixeira, Fernando Augusto Bozza and
Maicon Falavigna
Background: As
more patients are surviving intensive care, mental health concerns in survivors
have become a research priority. Among these, post-traumatic stress disorder
(PTSD) can have an important impact on the quality of life of critical care
survivors. However, data on its burden are conflicting. Therefore, this
systematic review and meta-analysis aimed to evaluate the prevalence of PTSD
symptoms in adult critical care patients after intensive care unit (ICU) discharge.
Methods: We
searched MEDLINE, EMBASE, LILACS, Web of Science, PsycNET, and Scopus databases
from inception to September 2018. We included observational studies assessing
the prevalence of PTSD symptoms in adult critical care survivors. Two reviewers
independently screened studies and extracted data. Studies were meta-analyzed
using a random-effects model to estimate PTSD symptom prevalence at different
time points, also estimating confidence and prediction intervals. Subgroup and
meta-regression analyses were performed to explore heterogeneity. Risk of bias
was assessed using the Joanna Briggs Institute tool and the GRADE approach.
Results: Of
13,267 studies retrieved, 48 were included in this review. Overall prevalence
of PTSD symptoms was 19.83% (95% confidence interval [CI], 16.72–23.13; I2 = 90%,
low quality of evidence). Prevalence varied widely across studies, with a wide
range of expected prevalence (from 3.70 to 43.73% in 95% of settings). Point
prevalence estimates were 15.93% (95% CI, 11.15–21.35; I2 = 90%; 17
studies), 16.80% (95% CI, 13.74–20.09; I2 = 66%; 13 studies), 18.96%
(95% CI, 14.28–24.12; I2 = 92%; 13 studies), and 20.21% (95% CI,
13.79–27.44; I2 = 58%; 7 studies) at 3, 6, 12, and > 12 months
after discharge, respectively.
Conclusion: PTSD
symptoms may affect 1 in every 5 adult critical care survivors, with a high
expected prevalence 12 months after discharge. ICU survivors should be screened
for PTSD symptoms and cared for accordingly, given the potential negative
impact of PTSD on quality of life. In addition, action should be taken to
further explore the causal relationship between ICU stay and PTSD, as well as
to propose early measures to prevent PTSD in this population.
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