A stay in intensive care unit can lead to depression

(Reuters Health) – A new study suggests that patients treated in an intensive care unit and who survive have an increased risk of depression. And researchers have found that depression among ICU survivors is associated with a higher risk of death over the next two years.

According to the study published in Critical Care, more than half of former ICU patients reported symptoms of psychological disorders, including anxiety, depression, and PTSD.

"Psychological problems – anxiety, depression, PTSD – after being treated for a critical illness in ICU are very common and oftentimes complex when they occur," said Robert Hatch, lead author of the study, researcher. academic in intensive care medicine and honorary researcher at the Institute. Associate Researcher at the University of Oxford. "Patients who reported symptoms of depression were 47% more likely to die from any cause in the first two years after leaving the ICU than those who did not report these symptoms."

Hatch and his colleagues followed 4,943 ICU patients who spent at least 24 hours in one of the 26 ICUs in the United Kingdom between 2006 and 2013. Patients were asked to complete a questionnaire 3 and 12 months after their discharge. intensive care.

The questionnaires looked for signs and symptoms of psychological disorders. In the analysis of the responses, the researchers determined that 46% of patients had symptoms corresponding to an anxiety diagnosis, 40% of symptoms of depression and 22% of symptoms of post-traumatic stress disorder. (PTSD). Often, patients had symptoms of more than one disorder. In fact, 18% of patients met the criteria for all three psychological problems.

Patients who reported symptoms consistent with a diagnosis of depression were 47% more likely to die from any cause in the first two years after leaving the ICU than those who did not report these symptoms. The increased risk of death has not been associated with symptoms of anxiety or post-traumatic stress.

"Detecting and recognizing psychological issues is so important is that they are a leading cause of the deterioration of quality of life after a serious illness and that they can potentially be treated," Hatch said in a letter. electronic. "Our findings suggest that depression following critical illness care in the intensive care unit may be a marker of poorer health, and clinicians should take this into account when following up with former ICU patients."

The new findings somewhat surprised Dr. John Bienvenu, an associate professor of psychiatry at Johns Hopkins Medicine.

"We knew that the symptoms of depression were associated with a deterioration in the quality of life after a critical illness," Bienvenu said. "But it shows that they are also associated with mortality. I was struck by the fact that they were 47% more likely to die. "

Welcome said a similar study in the United States would most likely lead to similar results.

Although the study does not explain why depression could shorten life, there are studies in other areas of medicine that could help clarify the subject, Bienvenu said. "In patients with diabetes and heart disease, depression affects not only what they feel, but also their behavior," he explained. "According to the diabetes literature, we know that depressed patients often do not take care of themselves as well: they do not take their medication and miss an appointment with their doctor."

The solution might be to better monitor patients after they leave the ICU, said Bienvenu. "At Hopkins, we are talking about doing a better job of screening for psychological symptoms in patients after their treatment and exit from the ICU," he added. "Then we can get treatment for all those who have positive screening."

SOURCE: bit.ly/2P1Pd5Y Critical Care, online November 23, 2018.