Posttraumatic stress phenomena in critical illness and intensive care survivors

The intensive care unit (ICU) within a hospital is typically thought of as a place for the provision of patient care for a life-threatening emergency. Less frequently do we consider it an integral part of disaster response. The COVID-19 pandemic is a public health disaster that has caused surges of critically ill patients requiring treatment in intensive care units (ICUs). However, it is important to bear in mind that survival of a critical illness can come at a cost, including to mental health. Being critically ill and requiring life-saving treatments is extremely stressful, and survivors frequently have substantial decrements in physical functioning, cognition, and emotional health. Remarkably, one in five critical illness survivors has clinically significant symptoms of posttraumatic stress disorder (PTSD). Risk factors, or markers of risk, include prior anxiety and depression, high doses of sedative medications in the intensive care unit (ICU), memories of nightmare-like experiences in the ICU, and emotional distress in early recovery. As with PTSD in other contexts, social support is a protective factor. ICU follow-up clinics, in-ICU psychological interventions, ICU diaries, post-ICU telephonic and computer-based cognitive-behavioral interventions, and virtual reality interventions all show promise in preventing long-term PTSD in critical illness survivors, perhaps particularly in those with substantial emotional distress in early recovery. However, awareness regarding this problem is still growing, as are changes to post-ICU care delivery. Hopefully, improved awareness on the part of the psychiatric community will help with recovery from the COVID-19 pandemic disaster.