Pilot exploration of post-traumatic stress symptoms in intensive care unit survivors in Cyprus

Nurs Crit Care. 2021 Mar;26(2):109-117. doi: 10.1111/nicc.12574. Epub 2020 Nov 9.


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.

Keywords: Davidson Trauma Scale; intensive care unit; post-intensive care syndrome; post-traumatic stress disorder; psychometric properties.

Publication types

  • Validation Study

MeSH terms

  • Cross-Sectional Studies
  • Cyprus / epidemiology
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Prevalence
  • Psychometrics
  • Reproducibility of Results
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Surveys and Questionnaires / standards*
  • Survivors / psychology
  • Survivors / statistics & numerical data*