Abstract
Objective Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. Materials and Methods In a prospective cohort study, patients with long-term mechanical ventilation requirements (n=131) were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU. Sociodemographic, psychological, and clinical risk factors with p values ≤ 0.1 were identified in a univariate logistic regression analysis and entered in a multivariable logistic regression model. A mediator analysis was run using the bootstrapping method, testing the mediating effect of perceived helplessness during the ICU stay, between the recalled traumatic experience from the ICU and a post-ICU MDD. Results 17.6% (n=23) of the patients showed a full- or subsyndromal MDD. Perceived helplessness, recalled experiences of a traumatic event from the ICU, symptoms of acute stress disorder, and the diagnosis of posttraumatic stress disorder (PTSD) after ICU could be identified as significant predictors of MDD. In a mediator analysis, perceived helplessness could be proved as a mediator. Conclusions Every fifth CCI patient suffers from MDD up to six months after being discharged from ICU. Particularly, perceived helplessness during the ICU stay seems to mainly affect the long-term evolvement of MDD. CCI patients with symptoms of acute stress disorder/PTSD should also be screened for MDD.
Highlights
An acute critical illness like multiple trauma, sepsis, or acute respiratory failure necessitates treatment in an Intensive Care Unit (ICU)
In a univariate logistic regression analysis, perceived helplessness in ICU, symptoms of acute stress disorder, the recalled experience of a traumatic event from the ICU stay, and a diagnosis of posttraumatic stress disorder (PTSD) could be identi ed as signi cant predictors of the diagnosis of major depressive disorder (MDD) up to six months after the transfer to post-acute ICU (Table S2, Supplementary Materials)
Our results reveal that nearly every fifth chronically critically ill patient is affected by a MDD up to six months following long-term mechanical ventilation in ICU
Summary
An acute critical illness like multiple trauma, sepsis, or acute respiratory failure necessitates treatment in an Intensive Care Unit (ICU). A certain group of patients with serious comorbidities and complications need prolonged invasive ventilation, entailing an increased risk for the development of the chronic critical illness syndrome. Core feature of chronic critical illness (CCI) is a ventilator dependence of at least three weeks [1]. CCI leads to an increased one-year mortality of about 58% and increases the risk for long-term institutional care [2, 3]. Prolonged life support with enduring dependence on mechanical ventilation set these patients at a state of debilitating physical and emotional well-being. Is has been referred to as post-intensive care syndrome (PICS) [4,5,6] Prolonged life support with enduring dependence on mechanical ventilation set these patients at a state of debilitating physical and emotional well-being. is has been referred to as post-intensive care syndrome (PICS) [4,5,6]
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