Sedative Medication Exposure in the ICU and PTSD Symptoms One Year Later: The Mediating Role of ICU Memory

Background: Exposure to medications with sedative properties in the intensive care unit (ICU) has been proposed as a contributor to long-term posttraumatic stress disorder (PTSD) symptoms, potentially through effects on memory processes during critical illness. Objectives: This study examined whether exposure to medications with sedative properties—sedatives, opioids, antipsychotics, and muscle relaxants—was associated with PTSD symptom severity 12 months after ICU discharge, and whether ICU memory mediated these associations. Methods: The sample consisted of 545 ICU survivors with PTSD outcome data; 537 also provided ICU memory data. Medication exposure within each class was operationalized using rank-based composite exposure scores to accommodate strongly right-skewed, zero-inflated dose distributions. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5), and ICU memory was assessed using a 4-point ordinal item. Associations were tested using bootstrapped linear...Show moreBackground: Exposure to medications with sedative properties in the intensive care unit (ICU) has been proposed as a contributor to long-term posttraumatic stress disorder (PTSD) symptoms, potentially through effects on memory processes during critical illness. Objectives: This study examined whether exposure to medications with sedative properties—sedatives, opioids, antipsychotics, and muscle relaxants—was associated with PTSD symptom severity 12 months after ICU discharge, and whether ICU memory mediated these associations. Methods: The sample consisted of 545 ICU survivors with PTSD outcome data; 537 also provided ICU memory data. Medication exposure within each class was operationalized using rank-based composite exposure scores to accommodate strongly right-skewed, zero-inflated dose distributions. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5), and ICU memory was assessed using a 4-point ordinal item. Associations were tested using bootstrapped linear regression and bootstrapped mediation models, adjusting for age, sex, and illness severity (APACHE-IV). Results: Higher exposure to sedative medications was associated with higher PTSD symptom severity for both cumulative and average daily exposure metrics, although effect sizes were small. Exposure to opioids, antipsychotics, and muscle relaxants was not significantly associated with PTSD symptoms. Mediation analyses showed statistically detectable indirect effects via ICU memory in some models; however, these effects were small and not consistent across medication categories and exposure metrics. Conclusions: The findings provide partial support for an association between sedative exposure during ICU admission and PTSD symptom severity one year after discharge. Evidence for mediation via ICU memory was limited, suggesting that medication exposure alone is unlikely to explain long-term PTSD outcomes following critical illness.Show less

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Sedative Medication Exposure in the ICU and PTSD Symptoms One Year Later: The Mediating Role of ICU Memory