Journal
PSYCHOSOMATIC MEDICINE
Volume 70, Issue 4, Pages 512-519Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PSY.0b013e31816aa0dd
Keywords
acute respiratory distress syndrome; depression; post-traumatic stress disorder; anxiety; critical care; outcome assessment (health care)
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Funding
- NHLBI NIH HHS [P050 HL 73994] Funding Source: Medline
- NIMH NIH HHS [K23 MH64543] Funding Source: Medline
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Objective: Acute lung injury (ALI), including its more severe subcategory, acute respiratory distress syndrome (ARDS), is a critical illness associated with considerable morbidity and mortality. Our objective was to summarize data on the prevalence of depressive, posttraumatic stress disorder (PTSD), and other anxiety syndromes amongst survivors of ALI/ARDS, potential risk factors for these syndromes, and their relationships to quality of life. Methods: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, and PsycINFO. Eligible studies reported data on psychiatric morbidity at least once after intensive care treatment of ALI/ARDS. Results: Ten observational studies met inclusion criteria (total n = 331). Using questionnaires, the point prevalence of clinically significant symptoms of depression ranged from 17% to 43% (4 studies), PTSD, 21% to 35% (4 studies); and nonspecific anxiety, 23% to 48% (3 studies). Studies varied in terms of instruments used, thresholds for clinical significance, baseline psychiatric history exclusions, and timing of assessments (range = I month to 8 years). Psychiatrist-diagnosed PTSD prevalence at hospital discharge, 5 years, and 8 years were 44%, 25%, and 24%, respectively. Three studies prospectively assessed risk factors for post-ALI/ARDS PTSD and depressive symptoms; significant predictors included longer durations of mechanical ventilation, intensive care unit stay, and sedation. All four studies that examined relationships between psychiatric symptoms and quality of life found significant negative associations. Conclusions: The prevalence of psychiatric morbidity in patients surviving ARDS seems high. Future research should incorporate more in-depth diagnostic and risk factor assessments for prevention and monitoring purposes.
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