Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis.

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2019-06-11 DOI:10.1186/s13054-019-2489-3

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, Maicon Falavigna

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引用次数: 133

Abstract

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.

Trial registration: PROSPERO, CRD42017075124 , Registered 6 December 2017.

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成人重症监护幸存者创伤后应激障碍症状的患病率:系统回顾和荟萃分析

背景:随着越来越多的患者在重症监护中幸存下来，幸存者的心理健康问题已成为研究的重点。其中，创伤后应激障碍(PTSD)对重症监护幸存者的生活质量有重要影响。然而，有关其负担的数据相互矛盾。因此，本系统综述和荟萃分析旨在评估重症监护病房(ICU)出院后成人重症监护患者PTSD症状的患病率。方法:检索MEDLINE、EMBASE、LILACS、Web of Science、PsycNET、Scopus等数据库，检索时间自成立至2018年9月。我们纳入了评估成人重症监护幸存者PTSD症状患病率的观察性研究。两位审稿人独立筛选研究并提取数据。使用随机效应模型对研究进行meta分析，以估计不同时间点PTSD症状的患病率，并估计置信区间和预测区间。进行亚组和元回归分析以探索异质性。使用Joanna Briggs研究所工具和GRADE方法评估偏倚风险。结果:在检索到的13267项研究中，48项纳入本综述。PTSD症状的总体患病率为19.83%(95%可信区间[CI]， 16.72-23.13;I2 = 90%，证据质量低)。各研究的患病率差异很大，预期患病率的范围很广(95%的环境中从3.70%到43.73%)。点患病率估计为15.93% (95% CI, 11.15-21.35;i2 = 90%;17项研究)，16.80% (95% CI, 13.74-20.09;i2 = 66%;13项研究)，18.96% (95% CI, 14.28-24.12;i2 = 92%;13项研究)，20.21% (95% CI, 13.79-27.44;i2 = 58%;7项研究)分别在出院后3、6、12和> 12个月进行。结论:每5名成人重症监护幸存者中就有1人出现PTSD症状，出院后12个月的预期患病率很高。鉴于创伤后应激障碍对生活质量的潜在负面影响，ICU幸存者应筛查PTSD症状并进行相应的护理。此外，还应进一步探讨ICU住院与PTSD之间的因果关系，并提出预防该人群PTSD的早期措施。试验注册:PROSPERO, CRD42017075124, 2017年12月6日注册。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.