Post-ICU Depressive Symptoms Correlate With Income, Education, and Function

Researchers of a study published in CHEST found that moderate to severe depressive symptoms after a stay in an intensive care unit (ICU) are associated with decreased income, lower education, and higher functional dependence. Moreover, age correlates curvilinearly with symptom severity.

The study included 246 participants from the RECOVER Phase 1 cohort recruited from 10 university hospital ICUs in Canada. Of these, 58% (n=143) were men, and the median age upon admission to the ICU was 56 (interquartile range [IQR], 45-65). The authors used linear mixed models to examine the correlation between depressive symptoms (determined using the Beck Depression Inventory II [BDI-II]) and participant characteristics including age, socioeconomic status, length of ICU stay (LOS), sex, and Charlson score; Functional Independence Measure (FIM) motor subscale score; and caregiver characteristics using the Center for Epidemiologic Studies Depression Scale (CES-D) and Caregiver Assistance Scale (CAS). Time points for assessment were 3, 6, and 12 months. Cubic splines were employed to allow for potential nonlinearity in the association between FIM, age, or ICU LOS and BDI-II score.

The median ICU LOS was 19 (IQR, 13-32) days. During 12-month follow up, 67 out of246 (27.2%) patients had a BDI-II score ≥20, indicating moderate-severe depressive symptoms. Mixed models demonstrated worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P =.007), incomplete secondary education (by 3.8 BDI-II points; P =.009), and showed a curvilinear relationship with age (P =.001), with highest BDI-II scores at ages 45-50. No associations were found between patient BDI-II and comorbidities (P =.92), sex (P =.25), ICU LOS (P =.51), or caregiver variables (CAS [P =.28] and CES-D [P =.74]).

Limitations to this study included a lack of information on functional status and depressive symptoms before hospitalization, incomplete questionnaires for a several participants, no investigation of depressive symptom trajectories over time, and likely bias toward well-educated participants owing to university hospital settings.

“In patients who have been ventilated ≥7 days, approximately one-quarter experience moderate to severe depressive symptoms following ICU discharge,” the researchers concluded. “Further research is needed to identify therapies that minimize the psychiatric morbidity associated with critical illness. In particular, the impact of early mobilization and physical recovery on depressive symptoms should be considered in any further studies examining critical care rehabilitation.”

Disclosures: Dr Ferguson reports consulting fees from Baxter, Getinge, and Sedana Medical.

Reference

Hamilton M, Tomlinson G, Chu L, et al; for the RECOVER Program Investigators and the Canadian Critical Care Trials Group. Determinants of depressive symptoms at one year after intensive care unit discharge in survivors of ≥7 RECOVER Phase 1 days of mechanical ventilation: results from the RECOVER program – a secondary analysis of a prospective multi-centre cohort study [published online May 15, 2019]. CHEST. doi:10.1016/j.chest.2019.04.104