Objective Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD, and the impact of post-ICU PTSD on health-related quality of life (HRQOL). Methods We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO, and a hand-search of thirteen journals. Results Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained “clinically significant” PTSD symptoms was 22% (n = 1,104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n = 93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration, and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL. Conclusions The prevalence of PTSD in ICU survivors is high and negatively impacts survivors’ HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives), and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients’ needs for early intervention.

Depressive symptoms are common in general ICU survivors and negatively impact HRQOL. Future studies should address how factors related to individual patients, critical illness and post-ICU recovery are associated with depression in ICU survivors.

Objective To compare acute lung injury (ALI) patients’ self-reported, retrospective baseline quality of life (QOL) before their intensive care hospitalization with population norms and retrospective proxy estimates. Design Prospective cohort study using the Short Form 36 (SF-36) QOL survey. Setting 13 intensive care units at 4 teaching hospitals in Baltimore, MD, USA. Patients 136 ALI survivors and their designated proxies. Interventions Both patients and proxies were asked to estimate patient baseline QOL before hospital admission using the SF-36 survey. Measurements and Main Results Compared to population norms, QOL scores were lower in ALI patients across all 8 domains, but the difference was significantly greater than the minimum clinically important difference in only 2 of 8 domains (Physical Role and General Health). The mean paired difference between patient versus proxy responses revealed no clinically important difference. However, kappa statistics demonstrated only fair to moderate agreement for all domains. Bland-Altman analysis revealed that for all domains, proxies tended to overestimate QOL when patient scores were low and underestimate QOL when patient scores were high. Conclusion Retrospective assessment of QOL prior to hospitalization revealed that ALI patients were consistently lower than population norms, but the magnitude of this difference may not be clinically important. Proxy assessments had only fair to moderate agreement with patient assessments. Across all 8 SF-36 QOL domains, proxy responses represented an attenuation of patient QOL estimates.