Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study

Abstract

Objective: To evaluate prevalence, severity, and co-occurrence of and risk factors for depression, anxiety, and posttraumatic stress disorder symptoms over the first year after acute respiratory distress syndrome.

Design: Prospective longitudinal cohort study.

Settings: Forty-one Acute Respiratory Distress Syndrome Network hospitals across the United States.

Patients: Six hundred ninety-eight acute respiratory distress syndrome survivors.

Interventions: None.

Measurements and main results: Psychiatric symptoms were evaluated by using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised at 6 and 12 months. Adjusted prevalence ratios for substantial symptoms (binary outcome) and severity scores were calculated by using Poisson and linear regression, respectively. During 12 months, a total of 416 of 629 patients (66%) with at least one psychiatric outcome measure had substantial symptoms in at least one domain. There was a high and almost identical prevalence of substantial symptoms (36%, 42%, and 24% for depression, anxiety, and posttraumatic stress disorder) at 6 and 12 months. The most common pattern of co-occurrence was having symptoms of all three psychiatric domains simultaneously. Younger age, female sex, unemployment, alcohol misuse, and greater opioid use in the ICU were significantly associated with psychiatric symptoms, whereas greater severity of illness and ICU length of stay were not associated.

Conclusions: Psychiatric symptoms occurred in two thirds of acute respiratory distress syndrome survivors with frequent co-occurrence. Sociodemographic characteristics and in-ICU opioid administration, rather than traditional measures of critical illness severity, should be considered in identifying the patients at highest risk for psychiatric symptoms during recovery. Given high co-occurrence, acute respiratory distress syndrome survivors should be simultaneously evaluated for a full spectrum of psychiatric sequelae to maximize recovery.

Figure 1

Patient flow diagram. *Reasons for not completing psychiatric assessments at 6 and 12 months, respectively: declined 8 and 7, physically incapable 7 and 5, cognitively incapable 6 and 4, receiving mechanical ventilation 3 and 3, psychiatric issues 2 and 3, incarcerated 2 and 2, unable to contact 3 and 1, lack of time 0 and 1, and other reason 1 and 4.

Figure 2

Venn diagram of co-occurrence of anxiety, depression, and PTSD symptoms among 325 patients with any psychiatric morbidity at 6-month follow-up. (Light grey area indicates co-occurrence of two psychiatric symptoms; dark grey area indicates co-occurrence of all three psychiatric symptoms).