New research in The Lancet Respiratory Medicine finds that one-third of intensive care patients experience depression. What is more, this depression will typically manifest as physical rather than psychological symptoms.
Every year in North America, 5 million people are admitted to medical or surgical critical care units - this is more people than are diagnosed with cancer. About 80% of these critical care patients survive, but previous studies have shown that survivors may experience post-intensive care syndrome.
To examine this further, the new study looked at mental health outcomes and functional disabilities in a general intensive care unit (ICU) population.
The researchers observed 821 critically-ill sepsis and respiratory failure patients admitted to medical or surgical ICUs in Nashville, TN. The surviving patients were assessed at intervals of 3 and 12 months for depression, PTSD, functional disability and impaired quality of life.
Two-thirds of ICU patients with depression display physical symptoms
At 3 months, 149 (37%) of the surviving 406 patients that were assessed had mild depression or more severe problems. Two-thirds of these surviving patients were displaying physical symptoms - such as weakness, appetite change and fatigue - rather than psychological symptoms. At 12 months, a third of the survivors who had depression were still displaying symptoms of depression.
"We need to pay more attention to preventing and treating the physical rather than psychological symptoms of depression in ICU survivors," says study leader Dr. James Jackson. He adds:
"The physical symptoms of depression are often resistant to standard treatment with antidepressant drugs and we need to determine how best to enhance recovery with a new focus on physical and occupational rehabilitation."
ICU survivors are three times more likely to suffer from depression than the average person.
The researchers found that the depressive symptoms were more likely to occur in patients with pre-existing depression. But it was also common in survivors with no history of psychiatric problems. At 3 months, 30% of patients with no psychiatric history were experiencing symptoms of depression, and 29% at 12 months.
The study also recorded high rates of disability in basic activities of daily life. These included inabilities to eat, bathe or dress without assistance. This described 32% of the survivors at 3 months and 27% at 12 months.
Similar difficulties to accomplish other day-to-day activities - such as managing money, making travel plans or writing a shopping list - were observed in 26% of patients at 3 months and 23% at 12 months.
However, PTSD was not as widespread in the patients as the depressive symptoms were. Only 7% of patients in the study displayed symptoms of PTSD.
Overall, the study suggests that ICU survivors are three times more likely to suffer from depression than the average person. It also reports that depression is four times more common than PTSD in people who have experienced critical illness.
Dr. Jackson suggests, therefore, that the amount of resource that goes into addressing PTSD in ICU patients may need to be revised in view of his team's findings:
"Substantial time and energy has been invested in addressing PTSD in survivors of critical illness, but our findings suggest that it is less pervasive than depression. Patients of all ages are at risk of developing post-ICU mental health and functional disabilities and more needs to be done to ensure that these impairments don't become permanent."
In 2012, Medical News Today reported on a study that found significant rates of anxiety and depression among ICU patients, and debated what could be done to improve the experience of intensive care for both the patients and their families.