Psychiatric Morbidity After Critical Illness

Prince, Elizabeth; Gerstenblith, Ted Avi; Davydow, Dimitry S.; Bienvenu, O. Joseph

doi:10.1016/j.ccc.2018.06.006

Cited by 34 publications

(42 citation statements)

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“…[5][6][7][8][9][10][11] Recent evidence has also shown an association between critical illness and psychiatric morbidity. 12 The combination of acute illness severity and resultant morbidity in ICU survivors (frequently called postintensive care syndrome) combine to make this group highly vulnerable to mental suffering. More specifically, ICU survivorship has been shown to be associated doi: 10.1136/bmj.n973 | BMJ 2021;373:n973 | the bmj with increased incidences of depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorders, and psychosis.…”

Section: Introductionmentioning

confidence: 99%

“…More specifically, ICU survivorship has been shown to be associated doi: 10.1136/bmj.n973 | BMJ 2021;373:n973 | the bmj with increased incidences of depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorders, and psychosis. [11][12][13][14][15] This increased risk of psychiatric morbidity in ICU survivors might lead to increased suicide and selfharm behaviours. Suicide is the 11th leading cause of death worldwide (second leading cause among adults younger than 35), and the incidence of suicide is increasing.…”

Section: Introductionmentioning

confidence: 99%

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Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design Population based cohort study using linked and validated provincial databases. Setting Ontario, Canada between January 2009 and December 2017 (inclusive). Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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“…Admission to the intensive care unit (ICU) is a stressful experience. The mental health problems associated with ICU admission have been broadly reported as posttraumatic stress, anxiety, and depression [1]. Substantial research has been undertaken in Europe and North America to identify rates, associated risk factors and preventative or therapeutic interventions [2].…”

Section: Introductionmentioning

confidence: 99%

“…In these studies, the rates of psychiatric morbidity are high (up to 20% of survivors). They are associated with increased functional impairment, health care burden, costs, and worse quality of life (QOL) [1,3]. There is, however, sparse data for post ICU mental health outcomes from the developing world -low, middleincome countries (LMIC).…”

Section: Introductionmentioning

confidence: 99%

Post traumatic stress symptoms, anxiety, and depression in patients after intensive care unit discharge – a longitudinal cohort study from a LMIC tertiary care centre

et al. 2020

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Background: Data on intensive care unit (ICU) related psychiatric morbidity from Low Middle-Income Countries are sparse. We studied the ICU related posttraumatic stress symptoms (PTSS), anxiety, and depression symptoms in a cohort of patients from Eastern India. Methods: We included adults admitted more than 24 h to a mixed ICU. PTSS, anxiety, and depression symptoms were assessed by telephonic or face to face interviews by using the Impact of Events-r (IES-r) and Hospital anxiety and depression (HADS), respectively, at 0, 7,14, 30, 90 and 180 days from ICU discharge. The loss to follow up was minimal. Demographic, socioeconomic, quality of life (QOL), and critical care related variables were studied. Results: Of 527 patients, 322 (59.4%) completed 6 months' follow up. The majority were male (60%), mechanically ventilated > 48 h (59.4%), mean age of 48 (+/− 16), mean acute physiology and chronic health evaluation II (APACHE II) at admission 9.4 (+/− 4.6), median length of stay 3 (2-28 days). The rates of ICU related clinical PTSS was < 1 and < 3% for anxiety/depression at any point of follow up. Data were analyzed by linear mixed (random effects) models. There was a significant drop in all scores and association with repeated measures over time. Poor QOL at discharge from the ICU showed significant association with PTSS, anxiety, and depression (β = − 2.94, − 1.34, − 0.7 respectively) when corrected for gender and education levels. Younger age, greater severity of illness, and prior stressful life experiences predicted worse PTSS (β = − 0.02, 0.08, 3.82, respectively). Benzodiazepines and lower sedation scores (better alertness) predicted lower depression symptoms. (β = − 0.43, 0.37 respectively). Conclusion: ICU related psychiatric morbidity rates in our population are low compared with reported rates in the literature. Poor QOL at ICU discharge may predict worse long-term mental health outcomes. Further research on the impact of ICU and sociocultural factors on mental health outcomes in patients from different backgrounds is needed. The study was registered at CTRI/2017/07/008959.

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“…Studies on patients from various types of intensive care units (ICUs) in the developed world have shown high rates of post-traumatic stress disorder (PTSD), anxiety and depression as much as 1 in 3–5 intensive care unit (ICU) survivors showing clinically significant symptoms at 1 years follow-up. 1 There are limited data however, on the incidence of psychiatric morbidity of ICU patients from developing countries in general and South Asian countries in particular. Studies of psychiatric morbidity of noncritically ill population from developing countries who have been subject to traumatic events have shown high rates of PTSD, but there is scant information about PTSD in the post-ICU patients from South Asia or India.…”

mentioning

confidence: 99%