Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study

Introduction There is growing evidence of poor mental health and quality of life among survivors of intensive care. However, it is not yet clear to what extent the trauma of life-threatening illness, associated drugs and treatments, or patients' psychological reactions during intensive care con...

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Published in:Critical care (London, England) Vol. 16; no. 5; p. R192
Main Authors: Wade, Dorothy M, Howell, David C, Weinman, John A, Hardy, Rebecca J, Mythen, Michael G, Brewin, Chris R, Borja-Boluda, Susana, Matejowsky, Claire F, Raine, Rosalind A
Format: Journal Article
Language:English
Published: London BioMed Central 15.10.2012
BioMed Central Ltd
Subjects:
Adult
Aged
Analysis
Anxiety - diagnosis
Anxiety - etiology
Anxiety - psychology
Cohort Studies
Critical Care - psychology
Critical Care - trends
Critical Care Medicine
Critically ill
Depression
Depression - diagnosis
Depression - etiology
Depression - psychology
Development and progression
Emergency Medicine
Female
Follow-Up Studies
Health aspects
Historical account
Hospitals
Humans
Intensive
Intensive Care Units - trends
Investigations
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Mental disorders
Mental Disorders - diagnosis
Mental Disorders - etiology
Mental Disorders - psychology
Mental health
Middle Aged
Morbidity
Post-traumatic stress disorder
Posttraumatic stress disorder
Prospective Studies
Psychological aspects
Psychology
Quality of life
Risk Factors
Time Factors
Intensive Care Unit
Psychological Morbidity
Illness Perception
Clinical Risk Factor
Chronic Physical Condition
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X
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Summary:Introduction There is growing evidence of poor mental health and quality of life among survivors of intensive care. However, it is not yet clear to what extent the trauma of life-threatening illness, associated drugs and treatments, or patients' psychological reactions during intensive care contribute to poor psychosocial outcomes. Our aim was to investigate the relative contributions of a broader set of risk factors and outcomes than had previously been considered in a single study. Methods A prospective cohort study of 157 mixed-diagnosis highest acuity patients was conducted in a large general intensive care unit (ICU). Data on four groups of risk factors (clinical, acute psychological, socio-demographic and chronic health) were collected during ICU admissions. Post-traumatic stress disorder (PTSD), depression, anxiety and quality of life were assessed using validated questionnaires at three months (n =100). Multivariable analysis was used. Results At follow-up, 55% of patients had psychological morbidity: 27.1% (95% CI: 18.3%, 35.9%) had probable PTSD; 46.3% (95% CI: 36.5%, 56.1%) probable depression, and 44.4% (95% CI: 34.6%, 54.2%) anxiety. The strongest clinical risk factor for PTSD was longer duration of sedation (regression coefficient = 0.69 points (95% CI: 0.12, 1.27) per day, scale = 0 to 51). There was a strong association between depression at three months and receiving benzodiazepines in the ICU (mean difference between groups = 6.73 points (95% CI: 1.42, 12.06), scale = 0 to 60). Use of inotropes or vasopressors was correlated with anxiety, and corticosteroids with better physical quality of life. The effects of these clinical risk factors on outcomes were mediated (partially explained) by acute psychological reactions in the ICU. In fully adjusted models, the strongest independent risk factors for PTSD were mood in ICU, intrusive memories in ICU and psychological history. ICU mood, psychological history and socio-economic position were the strongest risk factors for depression. Conclusions Strikingly high rates of psychological morbidity were found in this cohort of intensive care survivors. The study's key finding was that acute psychological reactions in the ICU were the strongest modifiable risk factors for developing mental illness in the future. The observation that use of different ICU drugs correlated with different psychological outcomes merits further investigation. These findings suggest that psychological interventions, along with pharmacological modifications, could help reduce poor outcomes, including PTSD, after intensive care.
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
DOI:10.1186/cc11677