From
MedPage Today:
Intensive care patients who suffered multiple organ failure, underwent surgery, or received high doses of benzodiazepine were at significantly increased risk for depressive symptoms six months after ICU discharge, researchers said.
Each of those factors more than doubled the likelihood that ICU survivors would test positive on a standard depression screening after six months, O. Joseph Bienvenu, M.D., Ph.D., of Johns Hopkins University, and colleagues reported online in Critical Care Medicine.
The findings could help clinicians identify former ICU patients who should receive extra monitoring for emergence of depressive symptoms after discharge, Dr. Bienvenu said in an interview.
The prospective study followed 160 consecutive patients with acute lung injury who were admitted to ICUs in four Baltimore area hospitals and survived at least six months after discharge.
At six months, participants were screened with the depression subscale of the Hospital Anxiety and Depression questionnaire, a common screening tool.
Because this seven-item questionnaire is not a bona fide diagnostic instrument, the researchers cautioned that the results indicate depressive symptoms but not clinical depression per se.
Dr. Bienvenu and colleagues found 26% of participants had positive results with the screening.
APACHE scores at ICU admission, length of ICU stay, and duration of mechanical ventilation were not significantly associated with depressive symptom scores, the researchers found.
Dr. Bienvenu said in an interview that the key element may be the maximum severity of illness during an ICU stay. For that, multiple organ failure is a better indicator than APACHE score or length of stay.
He also noted that the
benzodiazepine findings should be interpreted cautiously, as the question of causation does not have a clear answer and needs to be studied more directly.
It's unclear, he said, "whether it's causal in some way, for example, by causing more delirium in patients, or really whether it's just a marker of how agitated and emotionally upset patients were while they were critically ill."
Dr. Bienvenu also noted that the study did not address other aspects of participants' psychological health, such as the possible presence of post-traumatic stress or other forms of anxiety.
The researchers said their findings were limited by a lack of detailed information on pre-admission psychiatric history. The study also could have had a selection bias: about 18% of hospital survivors died within six months of acute lung injury and an additional 5 % were lost to follow-up.
Another 15% of potential participants either refused consent or were too sick to provide adequate follow-up data.