Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome

Abstract

Introduction: We investigated health-related quality of life (HRQoL) and persistent symptoms of post-traumatic stress disorder (PTSD) in long-term survivors of acute respiratory distress syndrome (ARDS). We wished to evaluate the influence of PTSD on HRQoL and to investigate the influence of perceived social support during intensive care unit (ICU) treatment on both PTSD symptoms and HRQoL.

Methods: In ARDS patients we prospectively measured HRQoL (Medical Outcomes Study 36-Item Short Form; SF-36), symptoms of PTSD (Post-Traumatic Stress Syndrome 10-Questions Inventory; PTSS-10), perceived social support (Questionnaire for Social Support; F-Sozu) and symptoms of psychopathology (Symptom Checklist-90-R); and collected sociodemographic data including current employment status. Sixty-five (50.4%) out of 129 enrolled survivors responded, on average 57 +/- 32 months after discharge from ICU. Measuring symptoms of PTSD the PTSS-10 was used to divide the ARDS patients into two subgroups ('high-scoring patients', indicating patients with an increased risk for developing PTSD, and 'low-scoring patients').

Results: HRQoL was significantly reduced in all dimensions in comparison with age- and gender-adjusted healthy controls. Eighteen patients (29%) were identified as being at increased risk for PTSD. PTSD risk was significantly linked with anxiety during their ICU stay. In this group of patients there was a trend towards permanent or temporary disability, independent of the period between discharge from ICU and study entry. Perceived social support was associated with a reduction in PTSD symptoms (Pearson correlation; p < 0.05). Post-hoc test revealed a significant difference between 'high-scoring patients' and 'low-scoring patients' with respect to mental health, although they did not differ in physical dimensions.

Conclusion: HRQoL was reduced in long-term survivors, and was linked with an increased risk of chronic PTSD with ensuing psychological morbidity. This was independent of physical condition and was associated with traumatic memories of anxiety during their ICU stay. Social support might improve mental health and consequently long-term outcome including employment status.

Figure 1

Study profile.

Figure 2

Subdimensions of health-related quality of life. Subdimensions of health-related quality of life were measured with the Medical Outcomes Study 36-Item Short Form (SF-36; physical function, physical role function, bodily pain, general health, vitality, social function, emotional function and mental health), comparing between patients with acute respiratory distress syndrome and age- and gender-matched healthy controls. Significant difference (***p < 0.0001) was calculated with t tests for independent samples.

Figure 3

Difference in mental and physical component summary between groups. The mental and physical component summary of health-related quality of life was measured with the Medical Outcomes Study 36-Item Short Form (SF-36), comparing between 'high-scoring patients' with a Post-Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10) score greater than or equal to the cutoff score of 35 points, indicating an increased risk for development of post-traumatic stress disorder, and 'low-scoring patients' with a PTSS-10 below the cutoff score, and age- and gender-matched healthy controls. Significant difference (***p < 0.0001)was calculated with analysis of variance and post-hoc t tests for independent samples. The broken line indicates a significant difference between groups as determined with the t test.

Figure 4

Correlation of perceived social support and posttraumatic stress. The total sum score of questionnaire F-Sozu and post-traumatic stress disorder (PTSD) score is shown. Severity of PTSD was verified with the Post-Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10) score. Diagnosis of an increased risk for development of PTSD was related to a cutoff score of 35 or more in PTSS-10. The cutoff score is denoted by a broken horizontal line; social support was significantly correlated to severity of PTSD (Pearson correlation; p < 0.05).