1 in 3 discharged ICU patients exhibit symptoms of depression

Of the over 5 million patients admitted to intensive care units (ICUs) each year, nearly 1 in 3 who are discharged may have persistent and clinically relevant symptoms of depression, a rate that is nearly 3 to 4 times that found in the general population, according to a recent review published in the September 2016 issue of the journal Critical Care Medicine.

“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,” said study co-author O. Joseph Bienvenu, MD, PhD, associate professor of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine, Baltimore, MD.

“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,” said senior author Dale Needham, MD, professor of medicine, Johns Hopkins University School of Medicine.

“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,” added Dr. Needham.

Drs. Needham and Bienvenu and colleagues conducted this review of five electronic databases (PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry [1970–2015]), which they searched for studies of depression after ICU stays from 1970 through March 13, 2015, in which patients were more than 16 years old and who were assessed for depressive symptoms after discharge.

In the 42 reports they found, which included 4,113 patients, the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) was the most commonly used assessment of depressive symptoms. Across the studies, the prevalence of depressive symptoms ranged from 4% to 64%, with a pooled prevalence of HADS-D of 8 or greater—representing mild depressive symptoms—of 29% at 2 to 3 months following discharge.

At this same time point, the pooled prevalence of HADS-D of 11 or greater—representing moderate to severe depression—was 17%; at 6 months, 17%; and at 12 to 14 months, 13%. In the first 12 months after discharge, symptoms were persistent, as demonstrated by the lack of significant changes in the prevalence of these symptoms.

The researchers also found a strong association between psychological symptoms that were present before the ICU stay and depressive symptoms after ICU discharge, and between the presence of psychological distress symptoms that occurred in the ICU or hospital—including anger, nervousness, and symptoms of acute stress such as emotional detachment or flashbacks.

They found no associations, however, between depressive symptoms and patient age, severity of illness, length of stay, or sedation duration. Finally, depressive symptoms were found to be correlated with greater anxiety and post-traumatic stress disorder symptoms, and worse quality of life.

In three studies, physical rehabilitation after discharge was assessed and found to be of potential benefit, but the use of a diary (assessed in two studies) and nurse-led ICU follow-up were not associated with any significant reductions in depressive symptoms.

Lead author Anahita Rabiee, MD, former Johns Hopkins researchers and internal medicine resident, Yale School of Medicine, New Haven, CT, concluded: “Identifying patients with pre-existing psychological comorbidity and psychological distress symptoms in the hospital may help maximize identification of depression and early intervention efforts. 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.”

This work was supported by the National Heart, Lung, and Blood Institute under grant number R24HL111895.