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Title: Pilot exploration of post-traumatic stress symptoms in intensive care unit survivors in Cyprus
Authors: Karanikola, Maria 
Alexandrou, George 
Mpouzika, Meropi 
Chatzittofis, Andreas 
Kusi-Appiah, Elizabeth 
Papathanassoglou, Elizabeth 
Major Field of Science: Medical and Health Sciences
Field Category: Health Sciences
Keywords: Davidson Trauma Scale;Intensive care unit;Post-intensive care syndrome;Post-traumatic stress disorder;Psychometric properties
Issue Date: Mar-2021
Source: Nursing in Critical Care, 2021, vol. 26, no. 2, pp. 109 - 117
Volume: 26
Issue: 2
Start page: 109
End page: 117
Journal: Nursing in Critical Care 
Abstract: Background Approximately, 20% of intensive care unit (ICU) survivors develop post‐traumatic stress disorder (PTSD) symptoms. Although Davidson Trauma Scale (DTS) provides a comprehensive approach to PSTD symptoms, there is no evidence on DTS‐I‐M use in ICU survivors. Aims and objectives To validate the modified intensity Davidson Trauma Scale (DTS‐I‐M) (wherein the frequency and severity subscales are combined to express symptoms intensity) in a convenience sample of ICU survivors in Cyprus, and to explore the prevalence of PTSD symptoms and related predictors. Design An instrument validation design, along with a cross‐sectional, correlational study design was employed. Methods Translation and cultural adaptation of the instrument were achieved through a group of experts and pilot testing. The DTS‐I‐M was administered via telephone. Participants' clinical data (length of ICU stay [LOS], mechanical ventilation duration [MVD], admission diagnosis, medication history) and demographics (age, gender) were collected. Non‐parametric comparisons, and regression analyses to identify predictors of DTS‐I‐M scores and PTSD symptoms were employed. Results The Cypriot DTS‐I‐M version demonstrated high test‐retest (Pearson's r = 0.928, P < .001) and internal consistency (Cronbach's [α] alpha = .97) reliability in a sample of 69 ICU survivors (62.7% response). About 36.2% of participants reported PTSD symptoms. Factor analysis confirmed the construct validity of the DTS‐I‐M, and a 3‐factor structure (encompassing intrusive, avoidance, hyperarousal, mood, and cognitive symptoms). In a multiple regression, MVD (B = −3.11, OR [95% CI] = 22.58 [3.07‐166.09, P = .002]) and LOS (r2 = 0.302, P = .002) were statistically significant predictors of DTS‐I‐M score. Conclusion We confirm the applicability of the DTS‐I‐M for the assessment of PTSD symptoms in ICU survivors; and offer preliminary evidence on the prevalence and predictors of post‐ICU PTSD symptoms in Cyprus. Relevance to clinical practice DTS‐I‐M is an appropriate screening tool for PTSD symptoms after ICU hospitalization. Patients with longer MVD and LOS are at higher risk for post‐ICU PTSD symptoms and seem to experience more intense relevant symptoms.
ISSN: 1478-5153
DOI: 10.1111/nicc.12574
Rights: © Wiley
Type: Article
Affiliation : Cyprus University of Technology 
Athalassa Psychiatric Hospital 
University of Cyprus 
Shacolas Educational Centre for Clinical Medicine 
University of Alberta 
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