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A majority of patients who survived life-threatening illnesses and spent a substantial amount of time in an intensive care unit (ICU), seemed to have a high risk of developing anxiety, persistent depression and post-traumatic stress disorder (PTSD).

Spending a substantial amount of time in ICU can result in physical issues such as urinary tract infections, stasis pneumonia, adult respiratory distress syndrome (ARDS), deep venous thrombosis (DVT) with possible embolism of the pulmonary arteries and bed-sores.

The effect of these physical complications, due to a stay in ICU, on the mental status of a patient is understood to be bad but the extent of which isn't known. Therefore, a study was conducted to determine how far these issues negatively affect a patient's psyche.

The study

Researchers conducted a multi-institutional study on a national level, which consisted of over 700 participants who had survived life-threatening situations and who had spent time in an ICU.

Six months after the events, 645 of these patients had data collected via a phone-based assessment, with 606 of the patients having a similar follow-up done after one year. 613 patients completed at least one psychiatric evaluation at six months follow-up, and 576 patients had completed at least one psychiatric evaluation after one year of follow-up.

An important limitation which needs to be addressed, is that only patients who had suffered from ARDS were included in this study. The risks mentioned therefore may not be applicable to patients who had other problems in the ICU.

The findings

The findings showed that, based on the self-reporting done at six months, 36% of the participating patients had shows signs of major depression. At the same follow-up time, 24% of patients had reported signs of PTSD and 42% exhibited signs of anxiety. At one year follow-up, the prevalence of these symptoms was nearly the same at 36%, 23% and 42%, respectively.

It was noted that of the patients who had experienced symptoms of depression, PTSD and anxiety at the six month follow-up stage, up to 66% of them were still experiencing the same symptoms at one year follow-up mark. Also, of the patients who didn't show substantial symptoms of depression, PTSD and anxiety at the six months follow-up stage, less than 15% of them then later developed these symptoms after one year. An important note was made that 63% of the participants, who were known to have a psychiatric illness, experienced two or more episodes of symptoms at both the six month and one year follow-up stages. 

Various other aspects were looked at in determining which of these would be classified as risk factors for the development of psychiatric symptoms after surviving a life-threatening illness and spending time in an ICU. These included the following:

  • Patients who were unemployed before their hospital admission were 26-40% more likely to experience psychiatric symptoms after being discharged.
  • Patients who misused alcohol were 39-79% more likely to experience the above-mentioned issues.
  • Patients who received opioid medication due to a longer ICU stay were at an 8-11% chance of experiencing the mentioned problems.
  • A younger age group (18-39) was up to 23% at risk of these issues.
  • Females are up to 80% at risk of developing symptoms.

The clinical significance 

The highest risk patients therefore would seem to be young, unemployed females who misuse alcohol, receive prolonged opioid medication in ICU and who are diagnosed with ARDS. Preventative and therapeutic measures therefore need to be put into place to help these patients.
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