Critically ill patients receiving mechanical ventilation had a higher prevalence of prior psychiatric diagnoses and an increased risk of a new psychiatric diagnosis and medication use after hospital discharge, according to a study based in Denmark.
With recent advances in medical care, more patients are surviving critical illness, according to background information in the study, which was published in the March 19 issue of the Journal of the American Medical Association. Critically ill patients are exposed to stress, including pain, respiratory distress and delirium, all of which may impact subsequent mental health. The extent of psychiatric illness prior to critical illness and the magnitude of increased risk of psychiatric illness following critical illness have been unclear.
Hannah Wunsch, MD, MSc, of Columbia University, New York City, and colleagues assessed psychiatric diagnoses and medication prescriptions before and after critical illness. The study included critically ill patients in Denmark from 2006-08 with follow-up through 2009, and matched comparison groups of hospitalized patients and the general population. Critical illness was defined as ICU admission with mechanical ventilation.
Among 24,179 critically ill patients included in the study, 6.2% had one or more psychiatric diagnoses in the five years prior to critical illness, compared with 5.4% for hospitalized patients and 2.4% for the general population. The proportion of five-year preadmission prescriptions for psychoactive drugs were similar to those for hospitalized patients (48.7% vs. 48.8%) but higher than those for the general population (33.2%).
Among the 9,921 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low but higher than that for hospitalized patients (0.5% vs. 0.2% over the first three months) and the general population group (0.02%). The proportion of patients given new psychoactive medication prescriptions also was higher in the first three months (12.7% vs 5% for the hospital group and 0.7% for the general population), but these differences largely had resolved by the end of the first year of follow-up.
The authors wrote that the study provides important data on the burden of psychiatric illness among patients who experience critical illness requiring mechanical ventilation, as well as on the risks of psychiatric diagnoses and treatment with psychoactive medications in the year following ICU discharge.
“Discharge planning for these patients may require more comprehensive discussion of follow-up psychiatric assessment and provision of information to caregivers and other family members regarding potential psychiatric needs.
Although the absolute risks were low, given the strong association between psychiatric diagnoses, such as depression, and poor outcomes after acute medical events, such as myocardial infarction and surgery, our data suggest that prompt evaluation and management of psychiatric symptoms may be an important focus for future interventions in this high-risk group.