Abstract
BackgroundSurvivors of critical illness have significant psychopathological comorbidity. The treatments offered by primary health care professionals to affected patients are unstudied.AimTo report the psychological interventions after GPs received notification of patients who showed severe symptoms of anxiety, depression or Post-Traumatic Stress Disorder.MethodsDesign: Multi-centre prospective cohort sub-study of the ICON study. Setting: NHS primary care in the United Kingdom. Participants: Adult patients, November 2006–October 2010 who had received at least 24 h of intensive care, where the general practitioner recorded notification that the patient had reported severe symptoms or caseness using the Hospital Anxiety and Depression Scale (HADS) or the Post-Traumatic Stress Disorder Check List-Civilian (PCL-C). Interventions: We notified general practitioners (GPs) by post if a patient reported severe symptoms or caseness and sent a postal questionnaire to determine interventions after notification. Main outcome measure: Primary or secondary healthcare interventions instigated by general practitioners following notification of a patient’s caseness.ResultsOf the 11,726 patients, sent questionnaire packs containing HADS and PCL-C, 4361 (37%) responded. A notification of severe symptoms was sent to their GP in 25% (1112) of cases. Of notified GPs, 65% (725) responded to our postal questionnaire. Of these 37% (266) had no record of receipt of the original notification. Of the 459 patients where GPs had record of notification (the study group for this analysis), 21% (98) had pre-existing psychopathology. Of those without a pre-existing diagnosis 45% (162) received further psychological assessment or treatment. GP screening or follow-up alone occurred in 18% (64) whilst 27% (98) were referred to mental health services or received drug therapy following notification.ConclusionsPostal questionnaire identifies a burden of psychopathology in survivors of critical illness that have otherwise gone undiagnosed following discharge from an intensive care unit (ICU). After being alerted to the presence of psychological symptoms, GPs instigate treatment in 27% and augmented surveillance in 18% of cases.Trial registrationISRCTN69112866 (assigned 02/05/2006).
Highlights
Survivors of critical illness have significant psychopathological comorbidity
Postal questionnaire identifies a burden of psychopathology in survivors of critical illness that have otherwise gone undiagnosed following discharge from an intensive care unit (ICU)
Participants Following discharge from ICU, 11,726 of 17,300 (68%) patients admitted to an ICU were alive and sent a patient questionnaire pack containing Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder Check ListCivilian (PCL-C) questionnaires at 3- or 12-month post-ICU discharge
Summary
Survivors of critical illness have significant psychopathological comorbidity. The treatments offered by primary health care professionals to affected patients are unstudied. Survivors of critical illness are at high risk of suffering long-term mental and psychological impairment after treatment on an intensive care unit (ICU) [1] with. Hatch et al Crit Care (2020) 24:633 around 33% suffering from symptoms associated with anxiety or depression [2, 3] and 19% suffering cliniciandiagnosed post-traumatic stress disorder (PTSD) [4, 5]. Survivors of critical illness experience a lower HRQoL than the general population [7]. The high psychopathological burden amongst ICU survivors is potentially treatable [4], and early treatment of these conditions can result in improved HRQoL [8]
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