ICU stays are associated with lasting psychiatric symptoms

About two-thirds of patients who survived a life-threatening illness reported persistent symptoms of at least one psychiatric condition—depression, anxiety, or post-traumatic stress disorder (PTSD)—after a stay in an intensive care unit (ICU), according to a study in the May issue of the journal Critical Care Medicine.

Patients who were young, female, unemployed, or misusing alcohol were at even higher risk, the results showed. But common risk factors of severity of illness and length of stay in the ICU were not associated with psychiatric symptoms.

The study, conducted at 40 hospitals across the United States, looked specifically at patients who had survived acute respiratory distress syndrome (ARDS) with a stay in the ICU.

Patients self-reported their symptoms at 6 months and again at 12 months after discharge. Trained staff assessed their symptoms by phone using validated questionnaires. Out of more than 600 patients, 36% reported signs of depression, 42% had signs of anxiety, and 24% reported signs of PTSD. At 12 months, the percentages of patients who reported these symptoms were still about the same—36% had depression, 42% had anxiety, and 23% had PTSD.

One-third of patients reported having symptoms of all three psychiatric conditions at the same time.

“Given the high co-occurrence of psychiatric symptoms, ARDS survivors should be simultaneously evaluated for a full spectrum of psychiatric consequences to maximize recovery,” said corresponding author Dale Needham, MD, Professor of Medicine and Medical Director of the Critical Care Physical Medicine and Rehabilitation Program at Johns Hopkins University School of Medicine, in Baltimore, MD.

The researchers noted that common risk factors associated with post-ARDS physical impairment and mortality, such as severity of illness and length of ICU stay, were not associated with psychiatric symptoms.

“It is critical for clinicians to recognize that patients with anticipated better physical outcomes, due to a lower severity of illness and shorter length of stay, should not be overlooked when considering risk for post-ICU psychiatric symptoms,” the authors wrote.

On the other hand, younger age, female sex, unemployment, alcohol misuse, and greater opioid use in the ICU were associated with greater risk of psychiatric symptoms.

“A longer duration of opioid exposure was the only ICU-related risk factor consistently and positively associated with symptoms in all three psychiatric domains,” the researchers wrote.

The authors acknowledged that the study was limited to ARDS patients only, so the findings may not be applicable to patients with other disorders in the ICU. “However, comparisons of our findings to the existing literature generally revealed consistency of results, which may support generalizability,” they wrote.

Given these findings, the researchers plan to investigate preventive and therapeutic measures that might help these patients. They also intend to look further into the complex role of in-ICU opioid administration and dosages.