People who survive a life-threatening illness in a hospital intensive care unit (ICU) can be at high risk for persistent mental health issues, especially younger patients and women.
Two-thirds of study participants who survived a condition called acute respiratory distress (ARD) syndrome after time in the ICU later reported symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD).
Of those who did report at least one post-ICU psychiatric symptom, a third said they experienced all three.
The severity of a patient’s ARD syndrome or length of time in the hospital surprisingly did not impact the chances that she or he would develop psychiatric symptoms. What was relevant was whether a patient was a woman, younger or unemployed or had misused alcohol prior to hospitalization.
“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,” says study leader Dale Needham, professor of medicine at the Johns Hopkins University School of Medicine.
“Given the high co-occurrence of psychiatric symptoms, ARDS survivors should be simultaneously evaluated for a full spectrum of psychiatric consequences to maximize recovery,” he says. “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.”
ARDS, which can be caused by infection or other problems, involves fluid buildup in the tiny air sacs of the lungs. It is often treated using mechanical ventilators. About 190,000 US cases of ARDS are reported each year, and nearly 75,000 people die.
Symptoms at 6 and 12 months
In the study, published in the journal Critical Care Medicine, 36 percent of former ARDS patients self-reported signs of depression, 42 percent showed signs of anxiety, and 24 percent showed signs of PTSD six months after their ICU hospitalizations.
At 12 months, prevalence of these symptoms was nearly the same—36, 42, and 23 percent, respectively.
Of the patients who experienced symptoms of depression, anxiety, or PTSD at six months, more than one-half—57 to 66 percent—still had the same symptoms at 12 months, indicating the persistence of the symptoms. The majority of survivors—63 percent—with any psychiatric illness experienced two or more symptoms at the same time at both six and 12 months.
“We know that depression, anxiety, and PTSD can significantly decrease quality of life,” says Minxuan Huang, a biostatistician at Johns Hopkins. “Understanding that patients will likely experience psychiatric symptoms after an ICU stay can help drive awareness and the development of improved mental health interventions.”
Researchers at Johns Hopkins and 40 other hospitals across the United States recruited 698 participants into the study. A total of 645 survivors had a phone-based assessment after six months, and 606 had a similar follow-up at one year. A total of 613 completed at least one psychiatric measure at six months by using standard surveys. At the one-year follow-up, 576 participants completed at least one psychiatric self-assessment.
Alcohol and painkillers
Across four age groups—18 to 39, 40 to 49, 50 to 59, and 60 to 89—the younger age group was 16 percent and 23 percent more likely to experience anxiety or PTSD, respectively, than its next older age group. Female patients were at 26 percent, 43 percent, and 80 percent 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 higher risk. Patients who were unemployed prior to hospitalization were 26 to 40 percent 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 percent and 8 to 11 percent higher risk of having psychiatric symptoms, respectively.
The study only looked at patients with ARDS, and the risks may not be applicable to those hospitalized in the ICU for other disorders, Needham says. Psychiatric symptoms were self-reported and not clinically diagnosed, although the self-testing instruments patients used are widely considered valid. The National Heart, Lung, and Blood Institute funded the study.
Source: Johns Hopkins University