Abstract
Background: Each year, tens of millions of people worldwide experience a critical illness (Crawford et al., 2023). Many survivors face substantial physiological challenges (Society of Critical Care Medicine, 2024). About 20% will also experience symptoms of posttraumatic stress disorder (PTSD) (Righy et al., 2019). Prior studies have shown that PTSD significantly reduces quality of life (Presciutti et al., 2020) and increases suicide risk (Fox et al., 2021). Limited access to specialized care (Johnston et al., 2019) may cause survivors in rural or low-resource areas to face greater mental health (MH) challenges and feel less capable of influencing their physical and MH.
Design/Purpose: A convergent mixed methods pilot study examined self-efficacy, powerlessness, and PTSD symptomology in critical illness survivors 90 days after ICU discharge. Survivors’ health goals, perceptions of barriers and facilitators to seeking MH treatment, and their influence on seeking MH treatment were also explored. Results were compared between rural and nonrural participants.
Results: Twenty-nine participants completed quantitative measures. Four participants scored in the moderate category for PTSD symptoms (14%); 3 were rural. None of those sought MH care. Mean PTSD symptom scores were similar (rural: 20.03, SD = 2.58; nonrural: 20.41, SD = 2.53). The means for powerlessness (rural: 20.24, SD = 6.98; nonrural: 17.06, SD = 3.94) and self-efficacy (rural: 34.48, SD = 3.91; nonrural: 36.25, SD = 3.28) differed. Significant correlations were discovered between PTSD and powerlessness (r = 0.50, p < 0.01) and powerlessness and self-efficacy (r = -0.67, p < 0.01). Two themes emerged from the qualitative data for health-related goals: (1) the ability to perform desired activities and (2) feeling well or healthy. Three provider-centric themes for barriers and facilitators to seeking MH treatment were identified: (1) established relationship, (2) assumed competence, and (3) proximity.
Conclusions: Critical illness survivors experience considerable challenges. Powerlessness appears to have a profound influence on survivorship and may inhibit rural survivors from seeking care despite experiencing MH symptoms. This study should be replicated with a larger sample. Meanwhile, nurses in hospitals and communities worldwide should intervene to reduce feelings of powerlessness in critical illness survivors, particularly those in rural and low-resource settings.
Notes
References:
1. Crawford, A. M., Shiferaw, A. A., Ntambwe, P., Milan, A. O., Khalid, K., Rubio, R., Nizeyimana, F., Ariza, F., Mohammed, A. D., Baker, T., Banguti, P. R., & Madzimbamuto, F. (2023). Global critical care: A call to action. Critical Care, 27(1), 28. https://doi.org/10.1186/s13054-022-04296-3
2. Fox ,V., Dalman, C., Dal, H., Hollander, A.C., Kirkbride, J.B., & Pitman, A. (2021). Suicide risk in people with post-traumatic stress disorder: A cohort study of 3.1 million people in Sweden. Journal of Affective Disorders, 279, 609-616. https://doi.org/10.1016/j.jad.2020.10.009.
3. Johnston, K.J., Wen, H., & Maddox, K.E.J. (2019). Lack of access to specialists associated with mortality and preventable hospitalizations of rural Medicare beneficiaries. Health Affairs, 38(12), 1993-2002. https://doi.org/10.1377/hlthaff.2019.00838.
4. Presciutti, A., Meyers, E.E., Reichman, M., & Vranceanu, A. (2021). Associations between baseline total PTSD symptom severity, specific PTSD symptoms, and 3-Month quality of life in neurologically intact neurocritical care patients and informal caregivers. Neurocritical Care, 34, 54–63. https://doi.org/10.1007/s12028-020-00980-w
5. Righy, C., Rosa, R.G., Amancia da Silva, R.T., Kochhann, R., Migliavaca, C.B., Robinson, C.C., Teche, S.P., Teixeira, C., Bozza, F.A., & Falavigna, M. (2019). Prevalence of posttraumatic stress disorder symptoms in adult critical care survivors: A systematic review and meta-analysis. Critical Care, 23(213), 1-13. https://doi.org/10.1186/s13054-019-2489-3.
6. Society of Critical Care Medicine. (2024). Critical care statistics. Retrieved October 12, 2024 from https://www.sccm.org/Communications/Critical-Care-Statistics
Sigma Membership
Beta Nu
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Health Equity or Social Determinants of Health, Public and Community Health, Critical Illness, Survivors, PTSD
Recommended Citation
Greene, Rebecca; Mastel-Smith, Beth; and McAlister, Barbara, "Survivorship by Setting: Mental Health-Related Phenomena in Critical Illness Survivors" (2025). International Nursing Research Congress (INRC). 76.
https://www.sigmarepository.org/inrc/2025/posters_2025/76
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Survivorship by Setting: Mental Health-Related Phenomena in Critical Illness Survivors
Seattle, Washington, USA
Background: Each year, tens of millions of people worldwide experience a critical illness (Crawford et al., 2023). Many survivors face substantial physiological challenges (Society of Critical Care Medicine, 2024). About 20% will also experience symptoms of posttraumatic stress disorder (PTSD) (Righy et al., 2019). Prior studies have shown that PTSD significantly reduces quality of life (Presciutti et al., 2020) and increases suicide risk (Fox et al., 2021). Limited access to specialized care (Johnston et al., 2019) may cause survivors in rural or low-resource areas to face greater mental health (MH) challenges and feel less capable of influencing their physical and MH.
Design/Purpose: A convergent mixed methods pilot study examined self-efficacy, powerlessness, and PTSD symptomology in critical illness survivors 90 days after ICU discharge. Survivors’ health goals, perceptions of barriers and facilitators to seeking MH treatment, and their influence on seeking MH treatment were also explored. Results were compared between rural and nonrural participants.
Results: Twenty-nine participants completed quantitative measures. Four participants scored in the moderate category for PTSD symptoms (14%); 3 were rural. None of those sought MH care. Mean PTSD symptom scores were similar (rural: 20.03, SD = 2.58; nonrural: 20.41, SD = 2.53). The means for powerlessness (rural: 20.24, SD = 6.98; nonrural: 17.06, SD = 3.94) and self-efficacy (rural: 34.48, SD = 3.91; nonrural: 36.25, SD = 3.28) differed. Significant correlations were discovered between PTSD and powerlessness (r = 0.50, p < 0.01) and powerlessness and self-efficacy (r = -0.67, p < 0.01). Two themes emerged from the qualitative data for health-related goals: (1) the ability to perform desired activities and (2) feeling well or healthy. Three provider-centric themes for barriers and facilitators to seeking MH treatment were identified: (1) established relationship, (2) assumed competence, and (3) proximity.
Conclusions: Critical illness survivors experience considerable challenges. Powerlessness appears to have a profound influence on survivorship and may inhibit rural survivors from seeking care despite experiencing MH symptoms. This study should be replicated with a larger sample. Meanwhile, nurses in hospitals and communities worldwide should intervene to reduce feelings of powerlessness in critical illness survivors, particularly those in rural and low-resource settings.
Description
This mixed-methods pilot study explored mental health-related phenomena in rural and nonrural critical illness survivors. PTSD symptomology was similar between the groups, but rural survivors experienced lower self-efficacy and increased powerlessness. Significant correlations between powerlessness and PTSD and powerlessness and self-efficacy suggest that powerlessness greatly impacts survivorship.