4. As shown, no variables were clearly identified as independent predictors for PTSD, anxiety and depression development at 12 months after ICU discharge. The subsequent multivariate new post analysis model showed that predictors were a GCS score <9 at admission for PTSD symptoms and a GCS score <13 at discharge for anxiety symptoms. No significant predictors were found for depression symptoms.Table 4Univariate and multivariate analysis for anxiety, depression and PTSD symptoms in overall populationaDiscussionThe main finding of this study is that, in a major trauma patient population, an early (intra-ICU) clinical psychologist intervention may have had a role in reducing the probability of a PTSD diagnosis at 12 months after discharge.

A recent review [21] encourages psychological support of ICU patients by nurses, which was found to be associated with a better outcome (vital signs, decrease in pain ratings, anxiety, rate of complications, LOS, sleep improvement and patient satisfaction), but to our knowledge, no studies have directly quantified the effects of early clinical psychologist intervention in the ICU setting.The symptoms of PTSD are clustered into three groups. The first two are specific to the traumatic etiology of the disorder: re-experience of the trauma and avoidance of stimuli likely to remind the patient of the trauma. Re-experience of the trauma includes intrusive memories and vivid images of the event during waking hours, which can be of such intensity that the person loses contact with their surroundings. Nightmares about the trauma are common.

Avoidance of stimuli likely to remind the patient of the trauma include avoiding conversation, places, people and activities associated with the trauma. The third symptom group consists of hyperarousal (sleep disturbances, irritability and difficulty with concentration), and this cluster of symptoms commonly occurs in other psychological disorders as well as PTSD. The high-risk PTSD prevalence in our control group was higher (57%) than that recently reported by Toien et al. [11] (18%) in 118 trauma patients followed up at 12 months. This notable difference can be attributed to the different questionnaire used. In the present study, the IES-R was used, which includes the evaluation of hyperarousal, so that the total score is higher than on the IES, and the validated cut-off for the definition of high-risk PTSD patients remained a score of 33 [17].

In our sample, anxiety and depression prevalence at 12 months was notably (but not significantly) lower in the intervention AV-951 group (Table (Table2).2). Since lack of significant results cannot authorize the conclusion regarding a beneficial effect of early clinical psychologist intervention, such differences encourage numerous further studies, also given that our statistics might be limited by the sample size.