Symptoms of anxiety, depression, and post-traumatic stress disorder 6 weeks and 6 months after ICU: Six out of 10 survivors affected

Authors

  • E van der Merwe Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa https://orcid.org/0000-0002-4628-8885
  • L Stroud Department of Psychology, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa https://orcid.org/0000-0002-3627-4121
  • G Sharp Department of Statistics, Faculty of Science, Nelson Mandela University, Gqeberha, South Africa https://orcid.org/0000-0003-0321-8067
  • N van Vuuren Adult Critical Care Unit, Livingstone Tertiary Hospital, Gqeberha, and Central University of Technology, Bloemfontein, South Africa
  • M Mosola Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
  • T Fodo Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
  • F Paruk Department of Critical Care, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa https://orcid.org/0000-0002-6549-0106

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i17.1988

Keywords:

Critical care, anxiety, depression, post-traumatic stress disorder, post ICU syndrome

Abstract

Background. Mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD) are being increasingly recognised as common adverse outcomes for critical illness survivors. These conditions can have lasting consequences on their wellbeing, ability to return to their pre-illness level of functioning and health-related quality of life. There is a paucity of South African data in terms of the psychological aspects of the post-intensive care unit (ICU) syndrome.

Objective. To identify and characterise patients who suffered from significant symptoms of mental health disease and poor mental health- related quality of life after ICU admission and who may benefit from appropriate referral, further investigation and medical intervention.

Methods. Critically ill patients in a multidisciplinary tertiary ICU were prospectively enrolled upon ICU discharge. Survivors were screened for anxiety, depression and post-traumatic stress syndrome at 6 weeks and 6 months after hospital discharge. The Hospital Anxiety and Depression Score (HADS) and the Impact Of Events Scale – Revised (IES-R) were used as screening tools. The mental component summary score (MCS) of the RAND short form-36 was used to determine the effect of psychological symptoms on health-related quality of life (HRQOL).

Results. The median age of the 107 ICU survivors was 42 years, and half of them were admitted for complications of COVID-19. Six out of every 10 ICU survivors experienced significant symptoms of anxiety, depression and/or PTSD at follow-up. At the 6-month study visit, 4 out of every 10 patients were experiencing significant psychological symptoms. Those affected had a significantly lower mental HRQOL when compared with those who were unaffected. More than half of those affected had co-occurrence of psychological symptoms. Significant symptoms of anxiety were common, with 5 out of every 10 participants experiencing significant symptoms at either, or both, of the study visits. More than 3 out of 10 of affected patients’ symptoms only occurred after the 6-week visit. Associations for significant psychological symptoms comprised female sex, younger age, a diagnosis of trauma and frightening memories of the ICU admission.

Conclusion. The burden of mental health disease in ICU survivors is substantial, affecting their HRQOL. Six out of 10 patients experienced symptoms of anxiety, depression and PTSD, and more than half of those affected experienced co-occurrence of the conditions. A third of those affected developed these symptoms only beyond 6 weeks after hospital discharge. A potentially modifiable association with psychological symptoms was frightening memories of the ICU stay.

Author Biographies

  • E van der Merwe, Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa

    Head Clinical Unit, Critical Care Unit, Livingstone Tertiary Hospital. Lecturer,  Faculty of Health Sciences, Nelson Mandela University. 

  • L Stroud, Department of Psychology, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa

    Professor, Department of Psychology, Nelson Mandela University

  • G Sharp, Department of Statistics, Faculty of Science, Nelson Mandela University, Gqeberha, South Africa

    Professor, `Department of Statistics, Nelson Mandela University

  • N van Vuuren, Adult Critical Care Unit, Livingstone Tertiary Hospital, Gqeberha, and Central University of Technology, Bloemfontein, South Africa

    Senior technologist, Critical Care Unit, Livingstone Tertiary Hospital 

  • M Mosola , Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa

    Specialist, Department of Critical Care, Livingstone Tertiary Hospital

  • T Fodo, Adult Critical Care Unit, Livingstone Tertiary Hospital and Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa

    Specialist, Department of Critical Care, Livingstone Tertiary Hospital

  • F Paruk, Department of Critical Care, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Professor, Head of Department of Critical Care, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria

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2024-07-01

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Research

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1.
van der Merwe E, Stroud L, Sharp G, van Vuuren N, Mosola M, Fodo T, et al. Symptoms of anxiety, depression, and post-traumatic stress disorder 6 weeks and 6 months after ICU: Six out of 10 survivors affected. S Afr Med J [Internet]. 2024 Jul. 1 [cited 2024 Jul. 18];114(7):e1988. Available from: https://samajournals.co.za/index.php/samj/article/view/1988

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