ArticlesDepression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study
Introduction
At least 5 million individuals are admitted to medical or surgical critical care units in North America every year—more than are diagnosed with cancer—and about 80% survive.1, 2 For these patients, critical illness can be a gateway to post-intensive care syndrome,3 which includes cognitive impairment, depression, post-traumatic stress disorder (PTSD), functional disabilities, and decrements in quality of life.4, 5, 6, 7, 8, 9
These outcomes have been studied in some critically ill populations (eg, patients with sepsis or acute respiratory distress syndrome), but typically only within a narrow age range of individuals, and they have rarely been assessed in general cohorts of patients in medical or surgical intensive care units (ICUs).10, 11 A third of survivors of acute respiratory distress syndrome are reported to have depression,4 but the precise nature of their symptoms or those of survivors of medical and surgical ICUs is unknown. Symptoms of post-traumatic distress disorder have been reported in up to half of survivors of critical illness,5 but prevalence according to Diagnostic and Statistical Manual (DSM) criteria in general medical and surgical populations is also unknown, particularly in the specific context of critical illness as a traumatic stressor.5 Functional disability in survivors of critical care from causes other than acute respiratory distress syndrome is poorly understood, although it has been assessed in some other specific contexts (eg, patients with sepsis).12 Finally, few investigations have explored delirium related to ICU admission—which is a potentially modifiable risk factor—in the emergence of mental health problems and functional difficulties.4, 5, 13
We aimed to characterise mental health outcomes and functional disabilities in a general ICU population and to explore the hypothesis that depressive symptoms after discharge are more often somatic (ie, bodily complaints) than cognitive–affective (ie, thought-related and mood-related complaints). We also aimed to test the effects of age across outcomes, with the hypothesis that younger patients have much the same symptoms of depression, PTSD, and functional disability as do older patients. Finally, we sought to determine if delirium is a risk factor for poor mental health and functional outcomes at 3 month and 12 month follow-up, testing the hypothesis that delirium is associated with depression, PTSD, and functional disabilities.
Section snippets
Study design and patients
In our prospective, observational cohort study, we screened adults aged at least 18 years with respiratory failure, cardiogenic shock, or septic shock who were admitted to medical or surgical ICUs at Vanderbilt University Medical Center or Saint Thomas Hospital (both Nashville, TN, USA). We excluded individuals who had been mechanically ventilated at any time in the 2 months before admission, spent more than 5 days in an ICU during the month before admission, or spent more than 72 h with organ
Results
We enrolled 826 patients between March 1, 2007, and June 30, 2010. Five patients withdrew consent and permission to use collected data; thus, we had 821 patients with in-hospital data and assessments. Of 10 558 days spent in the hospital by our patients, we did at least one complete mental assessment (delirium and coma) on 10 214 days (97%), thus only 3% of days were missing assessments. Between enrolment and 3 month follow-up, 252 (31%) patients died; 448 (79%) of 569 surviving patients
Discussion
Our large prospective cohort investigation yielded two main sets of observations related to mental health and functional outcomes in ICU survivors (panel). First, we noted that depression was five times more frequent than was post-traumatic distress disorder in ICU survivors, and its symptoms were most often driven by somatic rather than cognitive–affective components. Second, we noted that patients in this large cohort (including many with no reported history of psychiatric treatment) had
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