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von Oelreich E, Eriksson J, Eriksson M, Larsson E, Oldner A. Antidepressant drug use after intensive care: a nationwide cohort study. Sci Rep 2024; 14:15863. [PMID: 38982148 PMCID: PMC11233594 DOI: 10.1038/s41598-024-66028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
Modern intensive care has improved survival rates, but emerging evidence suggests a high prevalence of post-intensive care unit (ICU) health problems, including post-traumatic stress disorder, depression and anxiety. These symptoms may have a detrimental effect on quality of life and increase mortality. The primary objective of this study is to examine the extent of initiation of antidepressant medication among ICU survivors and identify the factors associated with its usage. The secondary objective is to investigate whether the use of these medications is linked to an increased mortality. The nationwide study cohort included 125,130 ICU survivors admitted between 2010 and 2017. Within the first 3 months after ICU discharge, 7% of patients initiated antidepressant medication, by 1 year 15.5% had started medication. We found no tendency to a decrease during the 2-year follow-up period. Factors associated with antidepressant use included middle age, female sex, psychiatric and somatic comorbid conditions, substance dependence, higher illness severity, and longer ICU stay. Antidepressant users had a higher mortality rate, and deaths due to external causes and suicide were more frequent in this group. This study emphasizes the importance of detecting and addressing depression in ICU survivors to improve their quality of life and reduce mortality rates.
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Affiliation(s)
- Erik von Oelreich
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Jesper Eriksson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Emma Larsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Oldner
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Du Z, Liu X, Li Y, Wang L, Tian J, Zhang L, Yang L. Depressive symptoms over time among survivors after critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 87:41-47. [PMID: 38306945 DOI: 10.1016/j.genhosppsych.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Critical illness survivors frequently experience various degrees of depressive symptoms, which hinder their recovery and return to daily life. However, substantial variability in the prevalence of depressive symptoms has been reported among critical illness survivors. The exact prevalence remains uncertain. METHODS A systematic search was performed in PubMed, Embase, CINAHL, and PsycINFO from inception to August 2023 for observational studies that reported depressive symptoms in adult critical illness survivors. The random-effects model was used to estimate the prevalence of depressive symptoms. Subgroup analysis and meta-regression were conducted to explore potential moderators of heterogeneity. Study quality was evaluated using the Joanna Briggs Institute's tool and the GRADE approach. RESULTS Fifty-two studies with 24,849 participants met the inclusion criteria. Overall prevalence estimate of depressive symptoms was 21.1% (95% CI, 18.3-24.1%). The prevalence of depressive symptoms remains stable over time. Point prevalence estimates were 21.3% (95% CI, 9.9-35.4%), 19.9% (95% CI, 14.6-25.9%), 18.5% (95% CI, 9.6-29.2%), 21.0% (95% CI, 16.8-25.5%), and 22.6% (95% CI, 14.4-31.8%) at <3, 3, 6, 12, and > 12 months after discharge from intensive care unit (ICU), respectively. CONCLUSIONS Depressive symptoms may impact 1 in 5 adult critically ill patients within 1 year or more following ICU discharge. An influx of rehabilitation service demand is expected, and risk stratification to make optimal clinical decisions is essential. More importantly, to propose measures for the prevention and improvement of depressive symptoms in patients after critical care, given the continuous, dynamic management of ICU patients, including ICU stay, transition to general wards, and post-hospital.
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Affiliation(s)
- Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Xiaojun Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Yuanyuan Li
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - Lina Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Jiaqi Tian
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Ling Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Lijuan Yang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China; Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China.
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da Rocha FR, Gonçalves RC, Prestes GDS, Damásio D, Goulart AI, Vieira AADS, Michels M, da Rosa MI, Ritter C, Dal-Pizzol F. Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study. CRITICAL CARE SCIENCE 2023; 35:147-155. [PMID: 37712803 PMCID: PMC10406403 DOI: 10.5935/2965-2774.20230422-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/16/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit. METHODS A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge. RESULTS Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder. CONCLUSION Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.
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Affiliation(s)
- Franciani Rodrigues da Rocha
- Laboratory of Translational Biomedicine, Postgraduate Program in
Health Sciences, Universidade do Extremo Sul Catarinense - Criciúma (SC),
Brazil
| | - Renata Casagrande Gonçalves
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
| | - Gabriele da Silveira Prestes
- Laboratory of Translational Biomedicine, Postgraduate Program in
Health Sciences, Universidade do Extremo Sul Catarinense - Criciúma (SC),
Brazil
| | - Danusa Damásio
- Research Centre, Hospital São José - Criciúma
(SC), Brazil
| | - Amanda Indalécio Goulart
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
| | - Andriele Aparecida da Silva Vieira
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
| | - Monique Michels
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
| | - Maria Inês da Rosa
- Laboratory of Translational Biomedicine, Postgraduate Program in
Health Sciences, Universidade do Extremo Sul Catarinense - Criciúma (SC),
Brazil
| | - Cristiane Ritter
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Postgraduate Program in
Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense -
Criciúma (SC), Brazil
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Estrup S, Kjer CKW, Vilhelmsen F, Ahmed N, Poulsen LM, Gøgenur I, Mathiesen O. Health-related quality of life, anxiety and depression and physical recovery after critical illness - A prospective cohort study. Acta Anaesthesiol Scand 2022; 66:85-93. [PMID: 34425002 DOI: 10.1111/aas.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/23/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Critical illness is often followed by mental and physical impairments. We aimed to assess the health-related quality of life (HRQoL), symptoms of anxiety and depression, and physical function in critically ill patients after discharge from the intensive care unit. METHODS For this prospective cohort study we included all available adult patients admitted to the ICU for >24 h during a 12-month period. Home visits took place at 3 and 12 months after discharge from the hospital and included Short-Form Health Survey (SF-36), Hospital Anxiety and Depression Scale, and Chelsea Critical Care Assessment Too (CPAx). RESULTS We visited 79 patients at 3 and 53 at 12 months. In patients with data from both visits the mental components SF-36 scores (median (IQR)) were 55 (43-63) at 3, and 58.5 (49.5-64) at 12 months; physical component SF-36 scores were 35 (28-45) at 3, and 36 (28-42) at 12 months. SF-36 subdomains of mental health, social functioning, and role emotional were close to normal. Vitality, bodily pain, general health, physical functioning, and role physical were severely affected. Incidences of anxiety and depression symptoms were 16%/8% at 3 and 13%/8% at 12 months) and physical function (CPAx) was 47 at both time points). CONCLUSION We found no change in HRQoL, anxiety, and depression, or physical function from 3 months to 1 year. Physical health-related quality of life was impaired at both time points. Subdomain scores for physical health-related quality of life were affected more than mental domains at both time points.
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Affiliation(s)
- Stine Estrup
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Cilia K. W. Kjer
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Frederik Vilhelmsen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Nadia Ahmed
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Lone M. Poulsen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Ismail Gøgenur
- Department of Gastrointestinal Surgery Center for Surgical Science Zealand University Hospital Køge Denmark
| | - Ole Mathiesen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen, Køge Denmark
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Pereira S, Cardoso T, Cavaco S. Reply to: Long-term psychological outcome after discharge from intensive care. Rev Bras Ter Intensiva 2019; 31:275-276. [PMID: 31090859 PMCID: PMC6649216 DOI: 10.5935/0103-507x.20190023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sara Pereira
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto - Porto, Portugal
| | - Teresa Cardoso
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto - Porto, Portugal
| | - Sara Cavaco
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto - Porto, Portugal
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Lima-Setta F, Faus DP, Campos FMC, Miliauskas CR. To: Long-term psychological outcome after discharge from intensive care. Rev Bras Ter Intensiva 2019; 31:111-112. [PMID: 30970096 PMCID: PMC6443305 DOI: 10.5935/0103-507x.20190014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Fernanda Lima-Setta
- Unidade de Terapia Intensiva Pediátrica, Instituto Fernandes Figueira - Rio de Janeiro (RJ), Brasil. Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | - Daniela Porto Faus
- Maternidade Escola, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil. Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | | | - Claudia Reis Miliauskas
- Setor de Saúde Ocupacional, Instituto Nacional de Metrologia, Qualidade e Tecnologia - Rio de Janeiro (RJ), Brasil. Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
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