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Observational Study
. 2024;15(1):2363654.
doi: 10.1080/20008066.2024.2363654. Epub 2024 Jun 17.

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness

Guillem Navarra-Ventura  1   2 , Marta Godoy-González  1   3 , Gemma Gomà  1   2 , Mercè Jodar  3   4   5 , Leonardo Sarlabous  1   2 , Verónica Santos-Pulpón  1   2 , Alba Xifra-Porxas  1   2 , Candelaria de Haro  1   2 , Oriol Roca  1 , Lluís Blanch  1   2 , Josefina López-Aguilar  1   2 , Sol Fernández-Gonzalo  1   3   5
Affiliations
Observational Study

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness

Guillem Navarra-Ventura et al. Eur J Psychotraumatol. 2024.

Abstract
in English, Spanish

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

Antecedentes: El ingreso en la unidad de cuidados intensivos (UCI) y la ventilación mecánica invasiva (VMI) se asocian con malestar psicológico y trauma. La pandemia de COVID-19 trajo consigo una serie de experiencias estresantes y traumáticas adicionales de larga duración. Sin embargo, se sabe poco sobre la depresión y el trastorno de estrés postraumático (TEPT) comórbidos.

Objetivo: Examinar la aparición, coexistencia, y persistencia de síntomas clínicamente significativos de depresión y TEPT, y sus factores predictivos, en supervivientes de enfermedad crítica por COVID-19.

Método: Estudio observacional prospectivo unicéntrico en adultos supervivientes de COVID-19 con ≥24 h de ingreso en UCI. Los pacientes fueron evaluados uno y 12 meses después del alta de UCI mediante la subescala de depresión de la Escala Hospitalaria de Ansiedad y Depresión y la Escala de Trauma de Davidson. Se analizaron las diferencias en los síntomas aislados y comórbidos de depresión y TEPT entre pacientes con y sin VMI y los predictores de la aparición y persistencia de síntomas de estos dos trastornos mentales.

Resultados: Ochenta y nueve pacientes (42 con VMI) completaron el seguimiento de 1 mes y 71 (34 con VMI) completaron el seguimiento de 12 meses. Un mes después del alta, el 29,2% de los pacientes presentaba síntomas de depresión y el 36% presentaban síntomas de TEPT; al cabo de un año, las cifras respectivas eran del 32,4% y el 31%. La coexistencia de síntomas de depresión y TEPT representó aproximadamente la mitad de todos los casos sintomáticos. Los síntomas de TEPT aislados fueron más frecuentes en pacientes con VMI (p≤0,014). La necesidad de VMI se asoció con la aparición al mes (OR = 6,098, p = 0,005) y la persistencia a los 12 meses (OR = 3,271, p = 0,030) de síntomas de cualquiera de estos dos trastornos mentales.

Conclusiones: Los síntomas comórbidos de depresión y TEPT fueron muy frecuentes en nuestra muestra de supervivientes de enfermedad crítica por COVID-19. La necesidad de VMI predijo la aparición a corto plazo y la persistencia a largo plazo de síntomas de estos dos trastornos mentales, especialmente de síntomas de TEPT. El papel específico de la disnea en la asociación entre la VMI y los trastornos mentales tras la UCI merece mayor investigación.

Keywords: Cuidados intensivos; Intensive care; depresión; depression; mechanical ventilation; mental health; post-intensive care syndrome; post-traumatic stress disorder; salud mental; síndrome post-cuidados intensivos; trastorno de estrés postraumático; ventilacion mecanica.

Plain language summary

Clinically significant depressive and post-traumatic stress disorder symptoms in survivors of COVID-19 critical illness, especially in patients who had undergone invasive mechanical ventilation, were highly frequent, occurred soon after discharge, and persisted over the long term.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of the study. Of the 365 patients with COVID-19 admitted to the ICU, 282 survived critical illness. Of these, 150 were included in the study. Eighty-nine patients completed the 1-month follow-up and 71 completed the 12-month follow-up. ICU, Intensive care unit; COVID-19, Coronavirus disease 2019.
Figure 2.
Figure 2.
Percentages (%) of clinically significant symptoms of depression and/or PTSD among symptomatic patients, overall and by IMV group. Depressive symptoms only (light grey, left area), PTSD symptoms only (medium grey, right area) and comorbid depressive and PTSD symptoms (dark grey, middle area). Percentages may not add up to 100% due to rounding. IMV, Invasive mechanical ventilation, PTSD, Post-traumatic stress disorder.
See this image and copyright information in PMC

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