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Depression affects one in three patients after intensive care

Prevalence of depression after time in the intensive care unit is three to four times higher than the general population

Ingrid Torjesen

Wednesday, 17 August 2016

Almost one in three people discharged from hospital intensive care units (ICUs) has clinically important and persistent symptoms of depression, according to research* published in the journal Critical Care Medicine.

The meta-analysis of reports on more than 4,000 patients show that the prevalence of depressive symptoms in this population is three to four times that of the general population and that in some symptoms can last for a year or more.

Researchers at the Johns Hopkins University School of Medicine searched five electronic databases to look for studies of depression after ICU stays that were conducted between 1970 and March 13, 2015. They found 42 reports involving 4,113 patients, who were assessed for depressive symptoms generally between one and 12 months after ICU discharge; 14 studies were conducted in the United Kingdom, and 10 were conducted in the United States.

The most common measurement of depressive symptoms (in 22 of the studies) was the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). The depression subscale determines the level of depressive symptoms a person is experiencing based on a 0 to 21 score, with a score of 0 to 7 being normal, 8 to 10 being mild, and 11 or greater being moderate to severe.

The researchers combined data, taking into account variations in the seven different measures of depressive symptoms used, and created a pooled "prevalence of depressive symptoms" statistic. Then, they calculated the change in the average depression scores on HADS, and depressive symptom prevalence between two months to six months, and from six to 12 months after discharge.

The prevalence of depressive symptoms across all studies ranged from 4 to 64%. The pooled prevalence of HADS-D greater than or equal to 8, representing at least mild depressive symptoms, was 29% two to three months following discharge, 34% six months after discharge and 29% 12-14 months after discharge. The pooled prevalence of HADS-D greater than or equal to 11, representing moderate to severe depressive symptoms, was 17% two to three months following discharge, 17% six months after discharge and 13% t 12 to 14 months after discharge.

No significant change in prevalence of depressive symptoms during the first 12 months after discharge, indicated persistence of symptoms during this time period, the researchers said. Psychological symptoms that existed before ICU stay were strongly associated with depressive symptoms after ICU discharge, as was the presence of psychological distress symptoms experienced in the ICU or hospital, including anger, nervousness and acute stress symptoms, such as emotional detachment or flashbacks. By contrast, patient age, severity of illness, ICU or hospital length of stay, and duration of sedation were not associated with depressive symptoms. Depressive symptoms were correlated with greater anxiety and post-traumatic stress disorder symptoms, and with worse quality of life.

Senior author Dale Needham, professor of medicine at the Johns Hopkins University School of Medicine, said: "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.

"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."

Rabiee A, et al. Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis. Crit Care Med. 2016 Sep;44(9):1744-53. doi: 10.1097/CCM.0000000000001811.

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