Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study.

Takeshi Unoki,Yuko Fukuda,Yosuke Satoi,Tomoki Kuribara,Takako Yamaguchi,Takahiro Tsujimoto,Mio Kitayama,Masako Shirasaka,Junpei Haruna,On Behalf Of The Smap-Hope Study Project ,Mayumi Hino,Yuko Shiba,Hideaki Sakuramoto,Takumi Nagao,Sakura Uemura,Yoshiki Masuda

doi:10.1371/journal.pone.0252167

Abstract

Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms.

Highlights

Many patients, once discharged from intensive care units (ICUs) and living at home, experience discomfort and struggle with memories of being in the ICU [1]
This study aimed to clarify the prevalence of mental health issues, including post-traumatic stress disorder (PTSD), anxiety, and depression, as well as the quality of life (QOL) of Japanese ICU survivors who were living at home one year after discharge in a multicenter study
A multicenter ambidirectional cohort study was conducted at 12 ICUs (S1 Text), including 10 medical–surgical ICUs, one medical–surgical ICU that specializes in emergency medicine, and one cardiovascular surgery ICU in different hospitals in various areas of Japan

Summary

Introduction

Once discharged from intensive care units (ICUs) and living at home, experience discomfort and struggle with memories of being in the ICU [1]. It is widely recognized that ICU survivors experience several symptoms post-discharge, including mental healthrelated disorders, impaired cognitive and physical function, and decreased quality of life (QOL) [2]. These new or worsened impairments during and after intensive care are known as post-intensive care syndrome (PICS) [3]. Psychological impairments post-ICU are associated with perceived unacceptable outcomes [4] and decreased QOL [5]. A previous study conducted in the UK reported that 18%, 38%, and 32% of patients had post-traumatic stress disorder (PTSD), anxiety, and depression, respectively—even one year after being discharged from an ICU [6]. A previous meta-analysis indicated that 19.8% of patients had significant PTSD after an ICU stay [7]

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