This article is more than 5 years old. Information may no longer be current.

ICU visits linked with increased psychiatric diagnoses, psychoactive prescriptions

Findings from a population-based cohort study demonstrate that patients with no former history of psychiatric illness who received mechanical ventilation as part of intensive care treatment were more likely to be newly diagnosed with psychiatric illness in the first few months following intensive care.

Using data from several Danish national medical databases, study author Hannah Wunsch, MD, MSc, of Columbia University, and colleagues assembled a population-based cohort study of critically ill patients in Denmark (n=24,179). The study included adults aged 15 years or older who were critically ill. In this study, critically illwas defined as having a first-time, nonsurgical ICU admission that required mechanical ventilation.

Patients were compared with non-ICU patients admitted to the same hospital and with members of the general population. Researchers noted an increased risk for preexisting schizophrenia, anxiety disorders, mood disorders and personality and behavior disorders in the critically ill cohort.

Data from hospitalizations occurring between 2006 and2008, with follow-up information from 2009, showed the following associations:

• 6.2% of patients in the critically ill cohort had one or more psychiatric diagnoses in the prior 5 years vs. 5.4% of hospitalized patients (P<.001) and 2.4% of members of the general population (P<.001).
• 5-year preadmission psychoactive prescription rates for the critically ill cohort were similar to those of hospitalized patients: 48.7% vs. 48.8% (P<.001) but were higher than those of the general population (P<.001).
• For critically ill patients with no psychiatric history (n=9,912), the absolute risk for new psychiatric diagnoses was slightly higher than hospitalized patients over the first 3 months (0.5% vs 0.2%; adjusted HR=3.42; 95% CI, 1.96-5.99) and the general population (0.02%; adjusted HR=21.77; 95% CI, 9.23-51.36).
• Instances of new psychiatric prescriptions were increased in the first 3 months: 12.7% for the critically ill cohort vs. 5.0% for the hospital cohort (adjusted HR=2.45; 95% CI, 2.19-2.74) and 0.7% for the general population (adjusted HR=21.09; 95% CI, 17.92-24.82).

The findings showed that differences in new psychiatric diagnosis rates between patients in the critically ill cohort and the general population were greatest in the first 3 months following ICU discharge; however, differences in rates were mostly resolved by 9 to 12 months after discharge. The increased risk for new psychoactive medication prescription was also higher at the three-month mark and resolved within the year following discharge.

Researchers wrote that additional ICU discharge practices may be warranted, including briefing patients on follow-up psychiatric assessments and providing caregivers with psychiatric resources that could help at-risk patients.

“Although the absolute risks were low, given the strong association between psychiatric diagnoses, such as depression, and poor outcomes after acute medical events, such as myocardial infarction and surgery, our data suggest that prompt evaluation and management of psychiatric symptoms may be an important focus for future interventions in this high-risk group,” researchers wrote.

Disclosure: The researchers reported no relevant financial disclosures.