Klett-Cotta-Verlag Psychology
Wissenschaft

Posttraumatische Belastungsstörung nach intensivmedizinischer Behandlung einer Sepsis

Patienten und deren Partner als Betroffene


November 2017, 11. Jahrgang, Heft 4, pp 308-318

DOI 10.21706/tg-11-4-308



Zusammenfassung
Nach einer Sepsis mit intensivmedizinischer Behandlung weist ein beachtlicher Anteil von Patienten Symptome einer posttraumatischen Belastungsstörung (PTBS) auf. Die Lebenspartner sind aufgrund der mit der Sepsis verbundenen Erlebnisse oftmals ebenfalls psychisch belastet und traumatisiert. Die psychische Gesundheit von Paaren ist in einem dyadischen Kontext zu betrachten, da Zusammenhänge (Konkordanzen) im Bereich der psychischen Belastung zwischen Lebenspartnern bereits mehrfach nachgewiesen wurden.
Die vorliegende Arbeit untersucht erstmals dyadische Zusammenhänge zwischen der PTBS-Symptomatik (gemessen mittels PTSS-10-Screening) von ehemaligen Sepsis-Patienten und deren Lebenspartnern sowie die partnerschaftliche Konkordanz. Dazu wurden zwei Stichproben ehemaliger Sepsis-Patienten und ihrer Lebenspartner analysiert. Der Anteil an Partnern mit klinisch relevant erhöhten PTSS-10-Werten ist ähnlich hoch ausgeprägt wie der der Patienten. Auf Paarebene zeigen sich als klein zu beurteilende korrelative Zusammenhänge sowie dyadische Konkordanzen hinsichtlich der PTBS-Symptomatik. Die Ergebnisse werden im Hinblick auf dyadische Interventionsansätze, bei denen sowohl Patient als auch Partner in die Behandlung einbezogen werden, diskutiert.

Abstract
Posttraumatic stress disorder after intensive care for sepsis – An examination of patients and their partners
After intensive care for sepsis, a lot of patients describe symptoms of posttraumatic stress disorder (PTSD). The partners often also suffer from psychological distress and are traumatised by the experiences associated with sepsis as well. The mental health in patients and their partners is to be viewed in a dyadic context, since there is evidence for concordance in psychological functioning of couples.
This study examines dyadic concordance in PTSD symptoms (screening assessed with PTSS-10) of former sepsis patients and their partners. Two samples of former sepsis patients and their partners were analysed. Results indicate that the proportion of partners with clinically relevant increased PTSD scores is similar to that of the patients. Within patient-partner-dyads small correlations can be found with respect to PTSD symptoms. There is evidence for dyadic concordance. The results are discussed regarding dyadic interventions, which involve both the patient and the partner.

  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  2. Badr, H. & Krebs, P. (2013). A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology, 22(8), 1688 – 1704.  DOI 10.1002/pon.3200 .
  3. Baucom, D. H., Belus, J. M., Adelman, C. B., Fischer, M. S. & Paprocki, C. (2014). Couple-based interventions for psychopathology: A renewed direction for the field. Family Process, 53(3), 445 – 461.  DOI 10.1111/famp.12075 .
  4. Bookwala, J. & Schulz, R. (1996). Spousal similarity in subjective well-being: the Cardiovascular Health Study. Psychology and aging, 11(4), 582 – 590.  DOI 10.1037/0882-7974.11.4.582 .
  5. Butterworth, P. & Rodgers, B. (2006). Concordance in the mental health of spouses: analysis of a large national household panel survey. Psychological medicine, 36(5), 685 – 697.  DOI 10.1017/S0033291705006677 .
  6. Cohen, J. (1992). A power primer. Psychological bulletin, 112(1), 155 – 159.  DOI 10.1037/0033-2909.112.1.155 .
  7. Davydow, D. S., Gifford, J. M., Desai, S. V., Needham, D. M. & Bienvenu, O. J. (2008). Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. General hospital psychiatry, 30(5), 421 – 434.  DOI 10.1016/j.genhosppsych.2008.05.006 .
  8. Di Castelnuovo, A., Quacquaruccio, G., Arnout, J., Cappuccio, F. P., De Lorgeril, M., Dirckx, C. & Zito, F. (2007). Cardiovascular risk factors and global risk of fatal cardiovascular disease are positively correlated between partners of 802 married couples from different European countries. Report from the IMMIDIET project. Thromb Haemost, 98(3), 648 – 655.  DOI 10.1160/TH07-01-0024 .
  9. Du Fort, G. G., Bland, R. C., Newman, S. C. & Boothroyd, L. J. (1998). Spouse similarity for lifetime psychiatric history in the general population. Psychological medicine, 28(4), 789 – 802.  DOI 10.1017/S0033291798006795 .
  10. Engel, C., Brunkhorst, F. M., Bone, H. G., Brunkhorst, R., Gerlach, H., Grond, S. & Mayer, K. (2007). Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive care medicine, 33(4), 606 – 618.  DOI 10.1007/s00134-006-0517-7 .
  11. Fleischmann, C., Thomas-Rueddel, D. O., Hartmann, M., Hartog, C. S., Welte, T., Heublein, S. & Reinhart, K. (2016). Hospital incidence and mortality rates of sepsis: an analysis of hospital episode (DRG) statistics in Germany from 2007 to 2013. Deutsches Ärzteblatt International, 113(10), 159 – 166.  DOI 10.3238/arztebl.2016.0159 .
  12. Gawlytta, R., Niemeyer, H., Böttche, M., Scherag, A., Knaevelsrud, C. & Rosendahl, J. (2017). Internet-based cognitive – behavioural writing therapy for reducing post-traumatic stress after intensive care for sepsis in patients and their spouses (REPAIR): study protocol for a randomised-controlled trial. BMJ open, 7(2), e014363.  DOI 10.1136/bmjopen-2016-014363 .
  13. Hagedoorn, M., Sanderman, R., Bolks, H. N., Tuinstra, J. & Coyne, J. C. (2008). Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychological bulletin, 134(1), 1.  DOI 10.1037/0033-2909.134.1.1 .
  14. Hagel, S. & Brunkhorst, F. M. (2011). Sepsis. Intensivmed 2011, 48, 57 – 73.  DOI 10.1007/s00390-010-0249-3 .
  15. Hatfield E., Cacioppo J. T., Rapson R. L. (1994). Emotional contagion: Studies in emotion and social interaction. New York: Cambridge University Press.
  16. Hickman Jr, R. L. & Douglas, S. L. (2010). Impact of chronic critical illness on the psychological outcomes of family members. AACN advanced critical care, 21(1), 80 – 91.
  17. Jaenichen, D., Brunkhorst, F. M., Strauß, B. & Rosendahl, J. (2012). Körperliche und psychische Langzeitfolgen nach intensivmedizinischer Behandlung einer schweren Sepsis bei Patienten und Angehörigen. PPmP – Psychotherapie · Psychosomatik · Medizinische Psychologie, 62(09/10), 335 – 343.  DOI 10.1055/s-0032-1306354 .
  18. Kaukonen, K. M., Bailey, M., Suzuki, S., Pilcher, D. & Bellomo, R. (2014). Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000 – 2012. Jama, 311(13), 1308 – 1316.  DOI 10.1001/jama.2014.2637 .
  19. Kayser, K., Watson, L. E. & Andrade, J. T. (2007). Cancer as a »we-disease«: Examining the process of coping from a relational perspective. Families, Systems & Health, 25(4), 404 – 418.  DOI 10.1037/1091-7527.25.4.404 .
  20. Krauseneck, T., Krähenmann, O., von Heimendahl, J., Schelling, G. & Padberg, F. (2007). Psychiatrische Erkrankungen auf der Intensivstation – Teil III: Psychische Reaktionen, affektive Erkrankungen und Angststörungen. Anästhesiol Intensivmed Notfallmed Schmerzther, 3, 180 – 187.  DOI 10.1055/s-2007-974579 .
  21. Küster, A., Niemeyer, H. & Knaevelsrud, C. (2016). Internet-based interventions for posttraumatic stress: A meta-analysis of randomized controlled trials. Clin Psychol Rev, 43, 1 – 16.  DOI 10.1016/j.cpr.2015.11.004 .
  22. Li, Q. & Loke, A. Y. (2014). A systematic review of spousal couple-based intervention studies for couples coping with cancer: direction for the development of interventions. Psycho-Oncology, 23(7), 731 – 739.  DOI 10.1002/pon.3535 .
  23. Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J. & Monson, C. M. (2016). Cognitive – behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157.  DOI 10.1037/fam0000177 .
  24. Mehlhorn, J., Freytag, A., Schmidt, K., Brunkhorst, F. M., Graf, J., Troitzsch, U. & Gensichen, J. (2014). Rehabilitation interventions for postintensive care syndrome: a systematic review. Critical care medicine, 42(5), 1263 – 1271.  DOI 10.1097/CCM.0000000000000148 .
  25. Monson, C. M. & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for PTSD: Harnessing the healing power of relationships. New York: Guilford Press.
  26. Monson, C. M., Fredman, S. J., Macdonald, A., Pukay-Martin, N. D., Resick, P. A. & Schnurr, P. P. (2012). Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. Jama, 308(7), 700 – 709.  DOI 10.1001/jama.2012.9307 .
  27. Moser, M. T., Künzler, A., Nussbeck, F., Bargetzi, M. & Znoj, H. J. (2013). Higher emotional distress in female partners of cancer patients: prevalence and patient–partner interdependencies in a 3-year cohort. Psycho-Oncology, 22(12), 2693 – 2701.  DOI 10.1002/pon.3331 .
  28. Myhren, H., Ekeberg, Ø., Tøien, K., Karlsson, S. & Stokland, O. (2010). Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Critical Care, 14(1), R14.  DOI 10.1186/cc8870 .
  29. Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H. & Brady, S. L. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical care medicine, 40(2), 502 – 509.  DOI 10.1097/CCM.0b013e318232da75 .
  30. Parker, A. M., Sricharoenchai, T., Raparla, S., Schneck, K. W., Bienvenu, O. J. & Needham, D. M. (2015). Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Critical care medicine, 43(5), 1121 – 1129.  DOI 10.1097/CCM.0000000000000882 .
  31. Raphael, B., Lundin, T. & Weisaeth, L. (1989). A research method for the study of psychological and psychiatric aspects of disaster. Acta Psychiatr Scand Suppl, 353, 1 – 75.  DOI 10.1111/j.1600-0447.1989.tb03041.x .
  32. Regan, T. W., Lambert, S. D., Girgis, A., Kelly, B., Kayser, K. & Turner, J. (2012). Do couple-based interventions make a difference for couples affected by cancer?: A systematic review. BMC cancer, 12(1), 279.  DOI 10.1186/1471-2407-12-279 .
  33. Rosendahl, J., Brunkhorst, F. M., Jaenichen, D. & Strauss, B. (2013). Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor – Partner Interdependence Model. Critical care medicine, 41(1), 69 – 75.  DOI 10.1097/CCM.0b013e31826766b0 .
  34. Shnaider, P., Pukay-Martin, N. D., Fredman, S. J., Macdonald, A. & Monson, C. M. (2014). Effects of cognitive – behavioral conjoint therapy for PTSD on partners’ psychological functioning. Journal of traumatic stress, 27(2), 129 – 136.  DOI 10.1002/jts.21893 .
  35. Stoll, C., Kapfhammer, H. P., Rothenhäusler, H. B., Haller, M., Briegel, J., Schmidt, M., Krauseneck, T. Schelling G. (1999). Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med, 25(7), 697 – 704.  DOI 10.1007/s001340050932 .
  36. Wintermann, G. B., Brunkhorst, F. M., Petrowski, K., Strauss, B., Oehmichen, F., Pohl, M. & Rosendahl, J. (2015). Stress disorders following prolonged critical illness in survivors of severe sepsis. Critical care medicine, 43(6), 1213 – 1222.  DOI 10.1097/CCM.0000000000000936 .
  37. Wintermann, G. B., Weidner, K., Strauß, B., Rosendahl, J. & Petrowski, K. (2016). Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care. Annals of intensive care, 6(1), 69.  DOI 10.1186/s13613-016-0174-0 .


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