Almost a third of patients in hospital intensive care units later experience symptoms of depression that can last a year or more.
The depressive symptoms occur at a rate three to four times that found in the general population, investigators say, and are particularly likely in patients with a history of psychological distress before ICU admission.
“It’s very clear that ICU survivors have physical, cognitive, and psychological problems that greatly impair their reintegration into society, return to work, and being able to take on previous roles in life,” says senior author Dale Needham, professor of medicine at Johns Hopkins University.
“If patients are talking about the ICU being stressful, or they’re having unusual memories or feeling down in the dumps, we should take that seriously. Health care providers, family members, and caregivers should pay attention to those symptoms and make sure they’re not glossed over.”
Psychological symptoms before an ICU stay and psychological distress during hospitalization—including anger, nervousness, and stress symptoms such as emotional detachment or flashbacks—were factors most associated with depressive symptoms after discharge. More than 5 million patients in the United States are admitted to ICUs each year.
“Not only can people with depression have slower physical recovery, but they also experience financial strain because they often cannot return to work and their caregivers must stay home with them,” says O. Joseph Bienvenu, associate professor of psychiatry and behavioral sciences and a coauthor of the study in the journal Critical Care Medicine.
For the study, researchers searched electronic databases for studies of depression after ICU stays by patients older than 16. They focused on 42 studies conducted from 1970 to March 2015, involving 4,113 patients assessed generally between one and 12 months after ICU discharge. The studies included male and female patients; 14 were conducted in the United Kingdom, 10 in the United States.
There was no significant change in prevalence of depressive symptoms during the first 12 months after discharge, indicating persistence of symptoms during this time period. Patient age, severity of underlying illness, length of ICU or hospital stay, and duration of sedation did not correlate with depressive symptoms.
“Identifying patients with pre-existing psychological comorbidity and psychological distress symptoms in the hospital may help maximize identification of depression and early intervention efforts,” says lead author Anahita Rabiee, now a resident at Yale University.
“And, given the strong relationship of depression with anxiety and PTSD symptoms after critical illness, patients who screen positive for depression should be evaluated for a full spectrum of psychological symptoms.”
The researchers caution that, in all but two studies they analyzed, depressive symptoms were assessed using questionnaires, most of which had not been rigorously evaluated for their performance in ICU survivors.
The National Heart, Lung, and Blood Institute funded the work.
Source: Johns Hopkins University