Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study
Open accessAbstract
Background Critical illness is associated with cognitive impairment, but mental health and functional disabilities in survivors of intensive care are inadequately characterised. We aimed to assess associations of age and duration of delirium with mental health and functional disabilities in this group.Methods In this prospective, multicentre cohort study, we enrolled patients with respiratory failure or shock who were undergoing treatment in medical or surgical ICUs in Nashville, TN, USA. We obtained data for baseline demographics and in-hospital variables, and assessed survivors at 3 months and 12 months with measures of depression (Beck Depression Inventory II), post-traumatic stress disorder (PTSD, Post-Traumatic Stress Disorder Checklist-Event Specific Version), and functional disability (activities of daily living scales, Pfeffer Functional Activities Questionnaire, and Katz Activities of Daily Living Scale). We used linear and proportional odds logistic regression to assess the independent associations between age and duration of delirium with mental health and functional disabilities. This study is registered with ClinicalTrials.gov, number NCT00392795.Findings We enrolled 821 patients with a median age of 61 years (IQR 51-71), assessing 448 patients at 3 months and 382 patients at 12 months after discharge. At 3 months, 149 (37%) of 406 patients with available data reported at least mild depression, as did 116 (33%) of 347 patients at 12 months; this depression was mainly due to somatic rather than cognitive-affective symptoms. Depressive symptoms were common even among individuals without a history of depression (as reported by a proxy), occurring in 76 (30%) of 255 patients with data at 3 months and 62 (29%) of 217 individuals at 12 months. Only 7% of patients (27 of 415 at 3 months and 24 of 361 at 12 months) had symptoms consistent with post-traumatic distress disorder. Disabilities in basic activities of daily living (ADL) were present in 139 (32%) of 428 patients at 3 months and 102 (27%) of 374 at 12 months, as were disabilities in instrumental ADL in 108 (26%) of 422 individuals at 3 months and 87 (23%) of 372 at 12 months. Mental health and functional difficulties were prevalent in patients of all ages. Although old age was frequently associated with mental health problems and functional disabilities, we observed no consistent association between the presence of delirium and these outcomes.Interpretation Poor mental health and functional disability is common in patients treated in intensive-care units. Depression is five times more common than is post-traumatic distress disorder after critical illness and is driven by somatic symptoms, suggesting approaches targeting physical rather than cognitive causes could benefit patients leaving critical care.Funding National Institutes of Health AG027472 and the Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System.
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As many as 66% of acute respiratory distress syndrome survivors report clinically important depression, anxiety, and PTSD symptoms at 1 year post-discharge.
“As many as 66% of acute respiratory distress syndrome (ARDS) survivors report clinically important symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) at 1 year post-discharge.5–8”
From Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: A pilot randomised clinical trial (2019) · cites this paper as [8]
The Mental Health Outcomes sections (page not provided) report depressive symptoms in 33% and probable PTSD in 7% of respondents at 12 months. This supports the presence of those symptoms after critical illness, but the study reports results for a general ICU cohort, not specifically ARDS survivors; it does not report anxiety or a 66% prevalence for the claimed combination. (LLM, conf=0.87)
Experimental — accuracy not yet measuredUp to one-third of general ICU survivors experience a poor quality of life, predominantly owing to psychological sequelae such as anxiety, depression, and PTSD.
“Up to one-third of “general” ICU survivors experience a poor quality of life, predominantly owing to psychological sequelae such as anxiety, depression, and posttraumatic stress disorder (PTSD) [4-7].”
From Intensive Care Unit–Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial (2022) · cites this paper as [6]
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- Authors
- Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., Pun, B. T., Vasilevskis, E. E., Morandi, A., Shintani, A. K., Hopkins, R. O., Bernard, G. R., Dittus, R. S., & Ely, E. W.
- Affiliations
- Vanderbilt University (US)
- Gruppo di Ricerca Geriatrica (IT)
- Brigham Young University (US)
- Corresponding author
- Jackson, James C
- ORCID
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 2
- Issue
- 5
- Pages
- 369-379
- ISSN
- 2213-2600 (ISSN-L)
- PMC
- PMC4107313
- OpenAlex
- W2100937752
- Cited by
- 673
- References
- 50
- Citations by year
- 2026: 46 · 2025: 63 · 2024: 51 · 2023: 55 · 2022: 61 · 2021: 73 · 2020: 69 · 2019: 59 · 2018: 57 · 2017: 47 · 2016: 45 · 2015: 29 · 2014: 17
- FWCI
- 37.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (AG045095, AG035117, R03AG045095, R01AG035117, K23AG040157, AG034257, K23AG031322, K23AG034257, AG027472, R01AG027472, AG040157)
- National Heart, Lung, and Blood Institute (R01HL111111, HL111111, HL087738-06, T32HL087738)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Keywords
- depression, post-traumatic stress disorder, functional disability, critical illness survivors, delirium, activities of daily living, instrumental activities of daily living, intensive care unit survivors, respiratory failure, shock, cognitive impairment, mental health, post-ICU recovery, long-term outcomes
- MeSH terms
- Activities of Daily Living, Age Factors, Aged, Cognition Disorders, Critical Care, Delirium, Depression, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Respiratory Insufficiency, Risk Factors, Shock, Stress Disorders, Post-Traumatic, Time Factors, Cohort Studies, Linear Models, Logistic Models, Critical Illness, Survivors
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