Specific characteristics of psychological trauma and the patient’s resilience process during and after hospitalisation in an intensive care unit ; Spécificités du traumatisme psychique et du processus de résilience du patient pendant et après une hospitalisation en réanimation

The extreme intensity and suddenness of intensive care is a real somatic and psychological catastrophe for the patient and constitutes a major risk factor for psychological trauma. Resilience, which has been rarely studied in the field of intensive care, is a dynamic phenomenon which involves adapting to traumatic situations by mobilising resources both internal and external to the individual in order to bounce back. In this context, the study of the resilience process represents a major challenge in reducing psycho-traumatic disorders and improving patient support. The aim of this PhD thesis is to gain a better understanding of the traumatic effects during and after resuscitation and the factors that promote or inhibit the resilience process in patients. From a multicentre, longitudinal perspective, the study is based on a mixed methodology. At 3 months and 1 year after resuscitation, patients hospitalised in a critical condition were asked to respond to 5 scales, including one assessing post-traumatic stress (IES-R) and resilience (CD RISC). Of the 382 patients included, 42 randomly identified patients underwent a semi-structured interview recorded by telephone 1 year after their hospitalisation and subjected to thematic content analysis using the grounded theory method. Of the 382 patients included, 18.7% had moderate to severe symptoms of PTSD and 53.1% had normal or high resilience (CD-RISC-25≥68). Among resilient patients, 12.8% had moderate to severe symptoms of PTSD (IES-R≥24) compared with 25.4% of non-resilient patients (p=0.002).The factors independently associated with higher resilience scores were greater social support (OR, 1.027; 95%CI, 1.008-1.047; p=0.005), a better perceived quality of life and a less threatening view of the disease (OR, 0.973; 95%CI, 0.950-0.996; p=0.02). Analysis of the resilience process in this context seems to echo the traumatic aspects of the experience. In fact, we were able to highlight a traumatic experience characterised by the physical and psychological disruption ...