Post‐Intensive Care Unit Psychiatric Comorbidity and Quality of Life

Wang, Sophia; Mosher, Chris; Perkins, Anthony J.; Gao, Sujuan; Lasiter, Sue; Khan, Sikandar; Boustani, Malaz; Khan, Babar

doi:10.12788/jhm.2827

Cited by 35 publications

(26 citation statements)

References 15 publications

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“…We confirm these findings by demonstrating that PTSD and depression are both associated with a considerable decrease in quality of life and that patients with psychological PICS have a worse quality of life compared to the general Dutch population in contrast with patients without psychological PICS. This is in line with a previous study by Wang et al, who demonstrated that the comorbidity of psychiatric symptoms is associated with a worse quality of life [33]. To improve the success of post-ICU clinics, treatment of psychological sequelae is critical to improve HRQoL.…”

Section: Discussionsupporting

confidence: 89%

“…Our findings go beyond describing the incidence of PICS in our cohort but clearly give a patient's opinion on the preference of needs and wishes on post-ICU interventions. To date, knowledge about the needs of patients suffering from PICS are scarce [33], and an effective treatment and thereby a uniform aftercare protocol is missing for patients suffering from PICS. Our findings can therefore be used to develop new treatment strategies, which can be implemented in an aftercare protocol in order to ameliorate the HRQoL of these patients.…”

Section: Discussionmentioning

confidence: 99%

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Patients suffering from psychological impairments following critical illness are in need of information

et al. 2020

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Background: Because critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics. Despite these and other initiatives, understanding of patient's post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs, expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived burden of psychological trauma after ICU treatment and the health-related quality of life (HRQoL) up to 2.5 years after ICU discharge. Methods: In a multicentre, retrospective cross-sectional cohort study, the needs and preferred intervention methods were assessed using a self-composed inventory in adult mechanically ventilated ICU survivors (n = 43). Additionally, the Impact of Event Scale Revised, the Beck Depression Inventory, the EuroQol-5D-5L, and the Short-Form 12 were used to assess psychological burden and HRQoL. Results: A substantial proportion of all ICU survivors (59%, 95% CI 44% to 74%) suffered from psychological impairments after ICU treatment. Seventy-five percent of these patients expressed a wish to receive information, but only 36% desired to receive this information using a commonly used information brochure. In contrast, 71% of these patients had a wish to receive information using a video film/VR. Furthermore, only 33% of these patients was satisfied with the information provided by their treating hospital. Patients with psychological PICS reported a worse HRQoL as compared to a normative Dutch sample (P < 0.001) and as compared to patients without psychological PICS (P < 0.01). Conclusions: In a Dutch cohort of critical illness survivors, a substantial part of ICU survivors suffer from psychological impairments, such as PTSD and depression, which was associated with a worse HRQoL. These patients are in need of information, have no desire using an information brochure, but are willing to receive information using a video film/virtual reality module. These results support the exploration of such an intervention.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Patients suffering from psychological impairments following critical illness are in need of information

et al. 2020

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“…40,41,54,72 Previous or current ICU survivorship research has applied several of the PHQ scales. 8,13,[73][74][75][76] While the ultra-short depression and anxiety screening tool PHQ-4 is part of the proposed PICS screening, we suggest the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 8-item depression scale (PHQ-8) for the extended assessment. The measurement quality of the PHQ-8 is equivalent to that of the PHQ-9, which has an additional item for thoughts of death and self-harm.…”

Section: Feasibility and Measurement Properties Of The Proposed Omismentioning

confidence: 99%

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test

Spies

Krampe

Paul

et al. 2020

Journal of the Intensive Care Society

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Background There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. Results We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). Conclusions We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).

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“…Future studies will need to further examine the effectiveness of ICU survivor clinic, but a small longitudinal study of CCRC found beneficial effects on patients’ cognitive and functional symptoms. 62 One major concern is that although psychiatric morbidity in ICU survivors is associated with adverse effects on patients’ quality of life and increased acute care service utilization after discharge from the ICU, 43,65 the role of mental health professionals in these ICU survivorship models has not been well-defined.…”

Section: Prevention and Treatment Of Deliriummentioning

confidence: 99%

Aging and Post–Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry

Wang

Allen

Kheir

et al. 2018

The American Journal of Geriatric Psychiatry

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Because of the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments because of critical illness, known as post-intensive care syndrome (PICS). This article focuses on PICS-related cognitive, psychological, and physical impairments and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS and what roles geriatric psychiatrists could play in the future of this rapidly growing population.

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Post‐Intensive Care Unit Psychiatric Comorbidity and Quality of Life

Cited by 35 publications

References 15 publications

Patients suffering from psychological impairments following critical illness are in need of information

Patients suffering from psychological impairments following critical illness are in need of information

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test

Aging and Post–Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry

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