Johns Hopkins study: ICU stays can increase risks of depression, anxiety, PTSD

Time spent in an intensive-care unit can increase the risks of depression, anxiety, and post-traumatic stress disorder, according to a new study from Johns Hopkins Medicine.

A report on the study, which looks specifically at patients who stayed in an ICU with the life-threatening condition of acute respiratory distress syndrome, or ARDS, is published in the latest issue of Critical Care Medicine.

The research shows that the risks for psychiatric disorders are higher for women and young people, and for those who are unemployed or misuse alcohol prior to their ICU stay. The report suggests that ARDS survivors should be evaluated "for a full spectrum of psychiatric consequences to maximize recovery," says study leader Dale Needham, a professor of medicine at Johns Hopkins.

The study enrolled nearly 700 ICU patients who survived ARDS—which involves fluid buildup in the tiny air sacs of the lungs and is often treated using life-support technology like mechanical ventilators. Two-thirds of study participants reported symptoms of either depression, anxiety, or post-traumatic stress. Moreover, one-third of the patients with at least one psychiatric symptom said they experienced all three conditions at once.

The patients' self-reported psychiatric symptoms appeared at roughly the same prevalence at six months and 12 months after their ICU stay. Most importantly, the researchers say, the majority of survivors with any psychiatric illness—63 percent— experienced two or more symptoms at the same time at both six and 12 months. Female patients were at 26 percent higher risk for depression, 43 percent higher risk for anxiety, and 80 percent higher risk for PTSD symptoms than male patients.

In the past, investigators say, research generally focused on the severity of the illness and the duration of the ICU stay when examining major risk factors for post-ICU impairments and mortality. Needham and his team say that age, gender, and joblessness should now be considered in assessing risks. Additionally, alcohol misuse, along with longer use of opioids in the ICU, are associated with higher risk of psychiatric symptoms.

ARDS affects an estimated 190,000 people and is responsible for nearly 75,000 fatalities each year. The researchers caution that because the study focused on ARDS, these risks may not be applicable to ICU stays for other disorders. They also note that the psychiatric symptoms were self-reported and not clinically diagnosed, though the self-testing instruments are widely considered valid for assessing depression, anxiety, and PTSD.

Needham and study co-author Minxuan Huang, a, biostatistician at the Johns Hopkins School of Medicine, say they plan to investigate preventive and therapeutic measures that might help ICU patients.

"Understanding that patients will likely experience psychiatric symptoms after an ICU stay can help drive awareness and the development of improved mental health interventions," says Huang.