Abstract:
Around 25% of intensive care unit (ICU) survivors will go on to develop post-traumatic stress disorder (PTSD). Risk factors for the development of PTSD in ICU survivors include the presence of delusional memories post-discharge, and lower cortisol levels post-trauma. To date, three small studies have investigated the effects of hydrocortisone (pharmaceutical cortisol) on subsequent PTSD symptoms, with promising results. Verbal emotional expression (VEE) post-discharge may represent another potential factor in the development of PSTD in ICU survivors, however, no research to date that has examined this relationship. The primary aim of this study was to further examine the effect of hydrocortisone, administered in the ICU, on PTSD symptoms in ICU survivors. Secondary aims were to examine the effect of hydrocortisone on delusional memory recall, and to investigate the relationship between delusional and factual memory recall and PTSD symptoms. A final aim was to investigate the relationship between VEE post-ICU-discharge and PTSD symptoms. This was a sub-study of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) study; a randomised, double-blind, placebo-controlled trial investigating the effect of hydrocortisone on ICU patients with septic shock. The current study measured PTSD, ICU memory recall, and VEE variables at 6-12 months post-discharge through telephone follow-up. The ADRENAL study has restricted treatment allocation codes until mid 2018, at which time the primary hypothesis for this sub-study will be tested. The remaining hypotheses regarding associations between memory, VEE, and PTSD outcomes, were examined using Spearman’s correlational analyses and Mann-Whitney U tests. Forty-three ICU patients from five New Zealand hospitals participated in this sub-study. At follow-up, 10 participants (23%) had moderate to extreme PTSD symptoms and four participants (9%) met criteria for a preliminary diagnosis of PTSD. PTSD scores were significantly associated with delusional memory scores, but not factual memory scores. Female participants reported significantly more PTSD symptoms, and younger participants recalled significantly more ICU memories. Forty-two participants (98%) reported engaging in ICU related VEE. A VEE frequency of ‘six or more times’ since discharge was reported by 27 participants (63%). Eighteen (42%) participants engaged in VEE with family and friends, while 24 participants (56%) engaged with family, friends and medical professionals. VEE was not associated with PTSD scores. This preliminary research is the first to investigate natural VEE in relation to PTSD symptoms in ICU survivors. Further longitudinal research is needed to more accurately estimate the frequency and content of VEE, as well as the direction of any associations with outcomes. Furthermore, once analyses are able to be performed regarding the effect of hydrocortisone on PTSD symptoms and delusional memory recall, this research will add to our understanding of whether hydrocortisone affects PTSD in ICU survivors. This research may inform future interventions.