Psychological and Psychosocial Factors

Being dependent on life support poses unique demands and stressors on LTMV patients, which result in psychological difficulties. These may include loss of autonomy and control, disruption of plans for the future, uncertainty about the future, permanent changes in physical appearance and bodily function, inability to communicate effectively, and diminished roles and responsibilities in the family and the society. 

Symptoms of anxiety and panic are commonly associated with a dependency on life support, communication difficulties, and uncertainty regarding health status (2). Many patients meet the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-fV) criteria for diagnosis of an anxiety disorder or a panic disorder. Posttraumatic stress disorder is sometimes the result of being close to death as well as the subsequent ICU experiences (3). If unmanaged, such psychiatric conditions will have important clinical consequences on adherence to recommended care and participation in rehabilitation. They will undoubtedly also influence health-related quality of life. 

Depression relates to the loss of autonomy, control and physical function, as well as altered family roles and relationships. Many patients meet DSM-IV criteria for the diagnosis of a major depressive episode or disorder. Feelings of helplessness, frustration, guUt, fear, and despair have also been reported among the LTMV population (4-6). Substance abuse also may increase among those with LTMV, requiring that the staff be sensitive to this issue (7). 

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