Patients at High Risk for Psychiatric Symptoms After a Stay in the ICU

BALTIMROE, Md -- April 20, 2016 -- Results of a multi-institutional national study of nearly 700 people who survived life-threatening illness with a stay in an intensive care unit (ICU) suggest that a substantial majority of them are at high risk for persistent depression, anxiety and post-traumatic stress disorder, especially if they are female, young, and unemployed.

The study, published in the May issue of the journal Critical Care Medicine, found that two-thirds of study participants who survived acute respiratory distress syndrome (ARDS) and spent time in the ICU self-reported symptoms of at least 1 of these psychiatric disorders, and one-third of those patients with at least 1 psychiatric symptom said they experienced all 3 at the same time.

Contrary to the common risk factors associated with post-ARDS physical impairments and mortality, such as severity of illness and length of ICU stay, the current study demonstrated that none of these risk factors had positive association with psychiatric symptoms.

“We need to pay more attention to the psychiatric vulnerability of ICU patients in recovery who are women, younger and unemployed prior to hospitalization, not just look at traditional measures of risk, such as greater illness severity and longer length of stay,” said Dale Needham, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland.

“Given the high co-occurrence of psychiatric symptoms, ARDS survivors should be simultaneously evaluated for a full spectrum of psychiatric consequences to maximise recovery,” he said. “We must pay heed to those who are not as severely ill as others when monitoring -- and considering ways to improve -- a person’s life after an ICU stay.”

For the study, researchers at Johns Hopkins and 40 other hospitals from across the United States recruited 698 participants. A total of 645 survivors had a phone-based assessment to collect data for the study at the 6-month follow-up, and 606 had a similar follow-up at 1 year. A total of 613 completed at least 1 psychiatric measure at 6 months by using the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised (IES-R) surveys.

Based on their self-reporting at 6 months, 36% of participants showed signs of depression, 42% showed signs of anxiety, and 24% showed signs of PTSD. At 12 months, prevalence of these symptoms was nearly the same -- 36%, 42%, and 23%, respectively.

Of the patients who experienced symptoms of depression, anxiety or PTSD at 6 months, more than one-half -- 57% to 66% -- still had the same symptoms at 12 months, indicating the persistence of the symptoms. Of the patients at 6 months without substantial symptoms of depression, anxiety or PTSD, less than 15% later developed symptoms by the 1 year mark.

Most important, the researchers said, the majority of survivors (63%) with any psychiatric illness experienced 2 or more symptoms at the same time at both 6 and 12 months.

Needham and his team say that young age, female gender and joblessness are important risk factors for having one or more psychiatric symptoms compared to severity of the illness and the length of stay, traditionally considered the major risk factors for post-ICU physical impairments and mortality.

According to the results from a multivariable analysis, across 4 age groups (18-39, 40-49, 50-59, and 60-89), the younger age group was 16% and 23% more likely to experience anxiety or PTSD, respectively, than its next older age group. Female patients had a 26%, 43%, and 80% higher risk than male patients for depression, anxiety, and PTSD symptoms, respectively.

Unemployment, alcohol misuse, and longer use of opioids in the ICU were also associated with the higher risk of psychiatric symptoms. Patients who were unemployed prior to hospitalization were 26% to 40% more likely to have psychiatric symptoms after hospital discharge. Similarly, patients with alcohol misuse or who received opioids for a longer duration during their ICU stay were at 39% to 79% and 8% to 11% higher risk of having psychiatric symptoms, respectively.

The authors cautioned that this study only looked at patients with ARDS, and the risks may not be applicable to those in the ICU with other disorders. They also noted that the psychiatric symptoms were self-reported and not clinically diagnosed, although the self-testing instruments they used are widely considered valid for assessing depression, anxiety, and PTSD symptoms.

SOURCE: Johns Hopkins Medicine
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