Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study

Abstract

Purpose: We aimed to characterize anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms over 5-year follow-up after acute respiratory distress syndrome (ARDS) and determine risk factors for prolonged psychiatric morbidity.

Methods: This prospective cohort study enrolled patients from 13 medical and surgical intensive care units in four hospitals, with follow-up at 3, 6, 12, 24, 36, 48, and 60 months post-ARDS. Trained research staff administered the Hospital Anxiety and Depression Scale (HADS) (scores ≥ 8 on anxiety and depression subscales indicating substantial symptoms) and the Impact of Event Scale-Revised (IES-R, scores ≥ 1.6 indicating substantial PTSD symptoms) at each follow-up visit.

Results: Of 196 consenting survivors, 186 (95%) completed HADS and IES-R assessments; 96 (52%) had any continuous or recurring (prolonged) symptoms, and 71 (38%), 59 (32%), and 43 (23%) had prolonged anxiety, depression, and PTSD symptoms, respectively (median total durations 33-39 months, 71-100% of observed follow-up time). Prolonged psychiatric symptoms tended to co-occur across domains; the most common morbidity pattern involved substantial symptoms in all three domains. Worse pre-ARDS mental health, including prior depression and psychological distress in the period immediately preceding ARDS, was strongly associated with prolonged post-ARDS psychiatric morbidity across symptom domains.

Conclusions: Clinically significant and long-lasting symptoms of anxiety, depression, and PTSD are common in the first 5 years after ARDS. In-hospital screening of psychiatric history, including recent anxiety and depression symptoms, may be useful for long-term mental health treatment planning after ARDS.

Keywords: Acute respiratory distress syndrome; Anxiety; Depression; Epidemiology; Patient outcomes; Posttraumatic stress disorder.

Figure 1. Flow diagram of study participants

^a Some patients had a follow-up visit but did not have complete Hospital Anxiety and Depression Scale (HADS) or Impact of Event Scale-Revised (IES-R) data for the following reasons, respectively, physically incapable/cognitively incapable/other: At 3 months, 22 did not have complete HADS data (9/5/8), and 23 did not have complete IES-R data (7/5/11). At 6 months, 12 did not have complete HADS data (4/2/6), and 13 did not have complete IES-R data (4/2/7). At 12 months, 14 did not have complete HADS data (5/4/5), and 15 did not have complete IES-R data (5/4/6). At 24 months, 10 did not have complete HADS data (0/6/4), and 11 did not have complete IES-R data (1/5/5). At 36 months, 8 did not have complete HADS data (0/3/5), and 9 did not have complete IES-R data (0/3/6). At 48 months, 7 did not have complete HADS or IES-R data (0/2/5). At 60 months, 7 did not have complete HADS or IES-R data (0/1/6). ^bThe study initially consented patients for 3, 6, 12 and 24-month follow-up. Upon receipt of a new grant for follow-up until 60 months, patients were required to provide new informed consent for the extended follow-up duration. The start of funding for this extended follow-up was delayed, resulting in 15 patients missing their 36-month follow-up

Figure 2. Venn diagram illustrating co-occurrence of prolonged anxiety, depression, and PTSD symptoms