Detecting acute distress and risk of future psychological morbidity in critically ill patients: validation of the intensive care psychological assessment tool

Abstract

IntroductionThe psychological impact of critical illness on a patient can be severe, and frequently results in acute distress as well as psychological morbidity after leaving hospital. A UK guideline states that patients should be assessed in critical care units, both for acute distress and risk of future psychological morbidity; but no suitable method for carrying out this assessment exists. The Intensive care psychological assessment tool (IPAT) was developed as a simple, quick screening tool to be used routinely to detect acute distress, and the risk of future psychological morbidity, in critical care units.MethodsA validation study of IPAT was conducted in the critical care unit of a London hospital. Once un-sedated, orientated and alert, critical care patients were assessed with the IPAT and validated tools for distress, to determine the IPAT’s concurrent validity. Fifty six patients took IPAT again to establish test-retest reliability. Finally, patients completed posttraumatic stress disorder (PTSD), depression and anxiety questionnaires at three months, to determine predictive validity of the IPAT.ResultsOne hundred and sixty six patients completed the IPAT, and 106 completed follow-up questionnaires at 3 months. Scale analysis showed IPAT was a reliable 10-item measure of critical care-related psychological distress. Test-retest reliability was good (r =0.8). There was good concurrent validity with measures of anxiety and depression (r =0.7, P <0.01; r =0.6, P <0.01). With a cut-point of ≥7, the IPAT had 82% sensitivity and 65% specificity to detect concurrent anxiety; and 80% sensitivity and 66% specificity to detect concurrent low mood (area under the curve (AUC) =0.8 for both). Predictive validity for psychological morbidity was good (r =0.4, P <0.01; r =0.64, P <0.01 for PTSD with days 1 and 2 data). The IPAT had 69% specificity and 57% sensitivity to predict future psychological morbidity (AUC =0.7).ConclusionsThe IPAT was found to have good reliability and validity. Sensitivity and specificity analysis suggest the IPAT could provide a way of allowing staff to assess psychological distress among critical care patients after further replication and validation. Further work is also needed to determine its utility in predicting future psychological morbidity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0519-8) contains supplementary material, which is available to authorized users.

Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients

“…In parallel, patients who had consented were assessed for acute stress using the Intensive care Psychological Assessment Tool (IPAT). 18 Patients scoring 7 points or more (high risk) were offered 3 one-to-one stress support sessions. These incorporated CBT approaches such as emotional expression, normalization, psychoeducation, cognitive reappraisal, and "homework" tasks.…”

The relation between skin conductance responses and recovery from symptoms of PTSD

“…Some attempts have been made to develop methods to identify ICU patients vulnerable for PTSS development . Such methods are mainly based on checklists including predisposing factors and emotional responses to ICU stimuli and the predictive accuracy has been found to be moderate .…”

A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT

“…Acute stress was detected if a patient scored ≥ 7 on the Intensive care Psychological Assessment Tool (IPAT), previously developed and validated at UCLH. 52 The three sessions included techniques adapted from CBT that were deemed appropriate for patients early in recovery, such as emotional expression, normalisation, cognitive reappraisal, psychoeducation and 'homework' tasks. Exposure to traumatic memories (one element of trauma-focused CBT) was not included as it was deemed inappropriate; for example, during the stress support sessions, patients are encouraged to express their thoughts and feelings about their critical care experiences if they wish, but not to undertake 'reliving' of their critical care stay, particularly as their trauma may be continuing.…”

“…Training was provided on how to screen patients using the IPAT. 52 A particular focus was on identifying strategies for ensuring adherence to the intervention, including plans for ensuring that all clinical critical care staff completed the POPPI online training course and that the POPPI nurses were given sufficient time to deliver stress support sessions with patients. Changes to the recruitment and data collection procedures were also outlined.…”

“…l Mean (10.3) and SD (10.8) of the PSS-SR. l ICC of 0.087 [95% confidence interval (CI) 0 to 0.192] (with mean, SD and ICC estimated using all available data from a previous observational study, 52 the feasibility study and the baseline period of the cluster RCT). l Treatment effect of a reduction of 4.2 points on the PSS-SRestimated by retaining the same effect size as a multiple of the within-site SD.…”