Psychosocial Issues Post ICU Discharge in Patients With Severe COVID-19

Following severe COVID-19 infection, patients commonly experience emotional problems, with those residing in the most deprived communities being less likely to return to work, according to a multicenter study published in BMJ Open Respiratory Research.

Studies have shown that patients who have been critically ill are at high risk of developing physical, psychosocial, and cognitive problems following discharge from the hospital. There are limited data on the long-term outcomes of those who have been severely ill due to COVID-19. Therefore, researchers performed an observational cohort study to evaluate the long-term psychosocial and physical consequences of severe COVID-19.

In the current study, investigators in Scotland invited patients who had been admitted to critical care units of 5 hospitals Between March and May 2020 due to severe COVID-19 to participate in an established recovery service between 3 and 7 months post-hospital discharge. Data gathered from the 93 patients (65.6% male; median age 59 years) in this COVID-19 cohort was then compared with a non-COVID-19 cohort of 182 critical care patients who had previously taken part in the recovery service and consented to be part of the current study. All study participants completed questionnaires concerning emotional, physical, and social recovery.

When investigators matched 91 (97.8%) patients in the COVID-19 cohort with 91 non-COVID-19 cohort patients, they found no significant differences between the 2 cohorts with respect to baseline demographics, BMI, comorbidities, pre-ICU mental health issues, and median Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. However, the analysis showed that patients in the COVID-19 cohort experienced longer-term physical, emotional, and social problems post discharge than those in the non-COVID-19 cohort.

The researchers found that within the COVID-19 cohort, emotional dysfunction was common (46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression). At follow-up, only 53.7% of previously employed patients had returned to employment, with lower numbers of patients residing in the most deprived areas returning to employment (P =.03). According to researchers, the high levels of new unemployment among COVID-19 survivors post discharge is also common in ICU survivors. Notably, those in the COVID-19 cohort who returned to employment had significantly shorter hospital stays (12.5 days vs 29 days, P <.01) and critical care stays (8.9 days vs 13.7 days, P =.01). Patients in this subgroup also had significantly lower APACHE II scores.

The researchers concluded, “Emotional and social problems are common in survivors of severe COVID-19 infection.”¹ Thus, “Coordinated rehabilitation is required to ensure patients make an optimal recovery.”

Reference

McPeake J, Shaw M, MacTavish P, et al. Long-term outcomes following severe COVID-19 infection: a propensity matched cohort study. BMJ Open Resp Res. 2021;8(1):e001080. doi:10.1136/bmjresp-2021-001080