55% of former ICU patients report symptoms of psychological disorders

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Patient and doctors in the emergency roomPatients who have survived critical illnesses requiring care in an intensive care unit (ICU) frequently report symptoms of anxiety, PTSD and/or depression, found a large UK study. Those reporting symptoms of depression after critical illness appear to be at a greater risk of death.

Researchers at the University of Oxford investigated psychological disorders in a cohort of 4,943 of former ICU patients. They found that 46% of patients reported symptoms of anxiety, 40% reported symptoms of depression and 22% reported symptoms of PTSD, while 18% of patients in the study reported symptoms of all three psychological conditions.

Dr Peter Watkinson, the corresponding author said: “Psychological problems after being treated for a critical illness in the ICU are very common and often complex when they occur. When symptoms of one psychological disorder are present, there is a 65% chance they will co-occur with symptoms of another psychological disorder.”

To investigate possible links between treatment in an ICU and symptoms of psychological disorders, the authors asked a total of 4,943 patients who received treatment in one of 26 ICUs in the UK between 2006 and 2013, to complete a questionnaire on their symptoms of anxiety, depression and PTSD three months after discharge from ICU and again 12 months after discharge.

The authors found that patients who reported symptoms of depression were 47% more likely to die from any cause (all-cause mortality) during the first two years after discharge from the ICU than those who did not report these symptoms.

Watkinson said: “Our findings suggest that depression following care of a critical illness in the ICU may be a marker of declining health and clinicians should consider this when following up with former ICU patients.”

The authors caution that the generalisability of the results outside of the UK may be limited as the data was only collected from UK based patients. Furthermore, the observational nature of the study and its reliance of self-reported data mean that it does not allow for conclusions about cause and effect between ICU care and symptoms of psychological disorders.

Abstract
Background: Survivors of intensive care are known to be at increased risk of developing longer-term psychopathology issues. We present a large UK multicentre study assessing the anxiety, depression and post-traumatic stress disorder (PTSD) caseness in the first year following discharge from an intensive care unit (ICU).
Methods:
Design: prospective multicentre follow-up study of survivors of ICU in the UK.
Setting: patients from 26 ICUs in the UK.
Inclusion criteria: patients who had received at least 24 h of level 3 ICU care and were 16 years of age or older.
Interventions: postal follow up: Hospital Anxiety and Depression Score (HADS) and the Post-Traumatic Stress Disorder (PTSD) Check List-Civilian (PCL-C) at 3 and 12 months following discharge from ICU.
Main outcome measure: caseness of anxiety, depression and PTSD, 2-year survival.
Results: In total, 21,633 patients admitted to ICU were included in the study. Postal questionnaires were sent to 13,155 survivors; of these 38% (4943/13155) responded and 55% (2731/4943) of respondents passed thresholds for one or more condition at 3 or 12 months following discharge. Caseness prevalence was 46%, 40% and 22% for anxiety, depression and PTSD respectively; 18% (870/4943 patients) met the caseness threshold for all three psychological conditions. Patients with symptoms of depression were 47% more likely to die during the first 2 years after discharge from ICU than those without (HR 1.47, CI 1.19–1.80).
Conclusions: Over half of those who respond to postal questionnaire following treatment on ICU in the UK reported significant symptoms of anxiety, depression or PTSD. When symptoms of one psychological disorder are present, there is a 65% chance they will co-occur with symptoms of one of the other two disorders. Depression following critical illness is associated with an increased mortality risk in the first 2 years following discharge from ICU.

Authors
Robert Hatch, Duncan Young, Vicki Barber, John Griffiths, David A Harrison, Peter Watkinson

Biomed Central material
Critical Care abstract


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