Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study

Robert Hatch, Duncan Young, Vicki Barber, John Griffiths, David A Harrison, Peter Watkinson, Robert Hatch, Duncan Young, Vicki Barber, John Griffiths, David A Harrison, Peter Watkinson

Abstract

Background: Survivors of intensive care are known to be at increased risk of developing longer-term psychopathology issues. We present a large UK multicentre study assessing the anxiety, depression and post-traumatic stress disorder (PTSD) caseness in the first year following discharge from an intensive care unit (ICU).

Methods: Design: prospective multicentre follow-up study of survivors of ICU in the UK.

Setting: patients from 26 ICUs in the UK.

Inclusion criteria: patients who had received at least 24 h of level 3 ICU care and were 16 years of age or older.

Interventions: postal follow up: Hospital Anxiety and Depression Score (HADS) and the Post-Traumatic Stress Disorder (PTSD) Check List-Civilian (PCL-C) at 3 and 12 months following discharge from ICU.

Main outcome measure: caseness of anxiety, depression and PTSD, 2-year survival.

Results: In total, 21,633 patients admitted to ICU were included in the study. Postal questionnaires were sent to 13,155 survivors; of these 38% (4943/13155) responded and 55% (2731/4943) of respondents passed thresholds for one or more condition at 3 or 12 months following discharge. Caseness prevalence was 46%, 40% and 22% for anxiety, depression and PTSD respectively; 18% (870/4943 patients) met the caseness threshold for all three psychological conditions. Patients with symptoms of depression were 47% more likely to die during the first 2 years after discharge from ICU than those without (HR 1.47, CI 1.19-1.80).

Conclusions: Over half of those who respond to postal questionnaire following treatment on ICU in the UK reported significant symptoms of anxiety, depression or PTSD. When symptoms of one psychological disorder are present, there is a 65% chance they will co-occur with symptoms of one of the other two disorders. Depression following critical illness is associated with an increased mortality risk in the first 2 years following discharge from ICU.

Trial registration: ISRCTN Registry, ISRCTN69112866 . Registered on 2 May 2006.

Keywords: Anxiety; Critical care; Critical illness; Depression; Intensive care; Multicentre study; Outcome assessment; PCL-C; PICS; PTSD; Post-Intensive Care Syndrome; Post-traumatic stress disorder; Post-traumatic stress disorder civilian checklist; Postal; Questionnaire; Survivors.

Conflict of interest statement

Ethics approval and consent to participate

This study was granted national ethics approval. Phases 1 and 2 - Oxford Research Ethics Committee B (REC 06/Q1605/17), phase 3 - South Central – Berkshire REC (11/SC/0172). Informed written consent to participate in the study was obtained from all patients who chose to respond to a questionnaire.

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Caseness distribution against time for the Hospital Anxiety and Depression Score (HADS) and Post-Traumatic Stress Disorder Check List - Civilian (PCL-C) at 3 and 12 months post ICU discharge
Fig. 2
Fig. 2
Analysis of change in the Hospital Anxiety and Depression Score (HADS)/Post-Traumatic Stress Disorder Check List - Civilian (PCL-C) in responders between 3 and 12 months post ICU discharge
Fig. 3
Fig. 3
Cross over in caseness - anxiety/depression and post-traumatic stress disorder (PTSD) caseness amongst responders
Fig. 4
Fig. 4
Survival versus depression (2 years) - Kaplan-Meier curve of 2-year survival amongst responders grouped by depression caseness. HADS, Hospital Anxiety and Depression Score
Fig. 5
Fig. 5
Hazard ratios showing the effect of known confounders (age, sex and illness severity), and anxiety, depression or post-traumatic stress disorder (PTSD) caseness on survival. APACHE, Acute Physiology and Chronic Health Evaluation; PCL-C, Post-Traumatic Stress Disorder Check List - Civilian

References

    1. Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011;39:371–379. doi: 10.1097/CCM.0b013e3181fd66e5.
    1. Judy E. Davidson, RN, CNS, DNP, FCCM; Ramona O. Hopkins, PhD; Deborah Louis, RN, MSN; Theodore J. Iwashyna, MD P (2013) Post-intensive care syndrome. In: Soc Crit Care Med . Accessed 12 Feb 2018.
    1. Nikayin S, Rabiee A, Hashem MD, et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2016;43:23–29. doi: 10.1016/j.genhosppsych.2016.08.005.
    1. Wade Dorothy M, Howell David C, Weinman John A, Hardy Rebecca J, Mythen Michael G, Brewin Chris R, Borja-Boluda Susana, Matejowsky Claire F, Raine Rosalind A. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Critical Care. 2012;16(5):R192. doi: 10.1186/cc11677.
    1. Samuelson KAM, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study. Acta Anaesthesiol Scand. 2007;51:671–678. doi: 10.1111/j.1399-6576.2007.01292.x.
    1. Rattray JE, Johnston M, Wildsmith JAW. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60:1085–1092. doi: 10.1111/j.1365-2044.2005.04336.x.
    1. Cuthbertson BH, Rattray J, Campbell MK, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes fromcritical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:1016. doi: 10.1136/bmj.b3723.
    1. Myhren H, Ekeberg Ø, Tøien K, et al. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010;14:R14. doi: 10.1186/cc8870.
    1. Rabiee A, Nikayin S, Hashem MD, et al. Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med. 2016;44:1744–1753. doi: 10.1097/CCM.0000000000001811.
    1. Wright JC, Plenderleith L, S a R. Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia. 2003;58:637–642. doi: 10.1046/j.1365-2044.2003.03205.x.
    1. Zivin K, Yosef M, Miller EM, et al. Associations between depression and all-cause and cause-specific risk of death: a retrospective cohort study in the Veterans Health Administration. J Psychosom Res. 2015;78:324–331. doi: 10.1016/j.jpsychores.2015.01.014.
    1. Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord. 2002;72:227–236. doi: 10.1016/S0165-0327(01)00413-X.
    1. Davydow DS, Gifford JM, Desai SV, et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30:421–434. doi: 10.1016/j.genhosppsych.2008.05.006.
    1. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296. doi: 10.1371/journal.pmed.0040296.
    1. Griffiths JA, Morgan K, Barber VS, Young JD. Study protocol: The Intensive Care Outcome Network (‘ICON’) study. BMC Health Serv Res. 2008;8. 10.1186/1472-6963-8-132.
    1. Hatch R, Young D, Barber V, et al. The effect of postal questionnaire burden on response rate and answer patterns following admission to intensive care: a randomised controlled trial. BMC Med Res Methodol. 2017;17. 10.1186/s12874-017-0319-3.
    1. Intensive Care Society . A Guide for critical care settings standards for critical incident reporting in critical care. 2005. p. 37.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Snaith RP, Zigmond AS. The Hospital Anxiey and Depression Scale with the Irritability-depression-anxiety Scale and the Leeds Situational Anxiety Scale: manual. 1994.
    1. Andrykowski MA, Cordova MJ, Studts JL, Miller TW. Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist - Civilian Version (PCL-C) as a screening instrument. J Consult Clin Psychol. 1998;66:586–590. doi: 10.1037/0022-006X.66.3.586.
    1. Harrison David A, Brady Anthony R, Rowan Kathy. Critical Care. 2004;9(Suppl 3):S1. doi: 10.1186/cc3745.
    1. NHS Digital . NHS digital - summary care records. 2016.
    1. R core team . R: A language and environment for statistical computing. Vienna: R Found. Stat. Comput; 2017.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829. doi: 10.1097/00003246-198510000-00009.
    1. Parker AM, Sricharoenchai T, Raparla S, et al. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015;43:1121–1129. doi: 10.1097/CCM.0000000000000882.
    1. Bienvenu OJ, Friedman LA, Colantuoni E, et al. Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med. 2018;44:38–47. doi: 10.1007/s00134-017-5009-4.
    1. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults lifetime prevalence of exposure to traumatic events. Arch Gen Psychiatry. 1991;48:216–222. doi: 10.1001/archpsyc.1991.01810270028003.
    1. Paparrigopoulos T, Melissaki A, Tzavellas E, et al. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014;18:25–31. doi: 10.3109/13651501.2013.855793.
    1. Gehlbach BK, Salamanca VR, Levitt JE, et al. Patient-related factors associated with hospital discharge to a care facility after critical illness. Am J Crit Care. 2011;20:378–386. doi: 10.4037/ajcc2011827.
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results. J Psychosom Res. 1997;42:17–41. doi: 10.1016/S0022-3999(96)00216-4.
    1. Jutte JE, Needham DM, Pfoh ER, Bienvenu OJ. Psychometric evaluation of the Hospital Anxiety and Depression Scale 3 months after acute lung injury. J Crit Care. 2015;30:793–798. doi: 10.1016/j.jcrc.2015.04.006.
    1. Williamson PR, Altman DG, Blazeby JM, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13:132. doi: 10.1186/1745-6215-13-132.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Dahm J, Wong D, Ponsford J. Validity of the depression anxiety stress scales in assessing depression and anxiety following traumatic brain injury. J Affect Disord. 2013;151:392–396. doi: 10.1016/j.jad.2013.06.011.
    1. Griffiths J, Fortune G, Barber V, Young JD. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007;33:1506–1518. doi: 10.1007/s00134-007-0730-z.
    1. Joseph S. Psychometric evaluation of Horowitz’s impact of event scale: a review. J Trauma Stress. 2000;13:101–113. doi: 10.1023/A:1007777032063.
    1. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD checklist (PCL) Behav Res Ther. 1996;34:669–673. doi: 10.1016/0005-7967(96)00033-2.

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