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Study finds depression 5 times more likely than PTSD in ICU survivors

In a study of adult ICU patients, researchers found depressive symptoms were mainly due to physical rather than cognitive-affective symptoms.

Participants included 821adults with a median age of 61 years who were admitted to medical or surgical ICUs with respiratory failure, cardiogenic shock or septic shock.

In the prospective cohort study, published in The Lancet Respiratory Medicine, researchers assessed quality of life using the Beck Depression Inventory II (BDI II), the Post-Traumatic Stress Disorder Checklist and Physical Component Score among 448 patients at 3 months and 382 patients at 12 months after hospital discharge. Data were available for 406 patients at 3 months and 347 at 12 months.

 

James C. Jackson

Patients felt at least mildly depressed in 37% of cases at 3 months and in 33% at 12 months.

The study stated that test scores on the BDI II were higher on the somatic than the cognitive-affective scale at both 3 and 12 months. Specifically, 66% of 149 patients with at least mild depression at 3 months would have met criteria for depression based solely on the seven items comprising the somatic subscale, while only 8% would have met criteria based entirely on the cognitive-affective subscale, according to researchers.

Similarly, 72% of 116 patients with mild depression at 12 months would have met depression criteria based solely on the somatic items, and only 4% would have met criteria based on cognitive-affective items.

Symptoms of posttraumatic stress disorder occurred among 7% of patients, while 32% of patients at 3 months and 27% at 12 months had a basic activities of daily living disability.

At 3 months, researchers noted no significant association between duration of delirium and depression, symptoms of PTSD, ADL or quality of life.

 “Public health approaches should put an emphasis on prevention and management of depression in ICU survivors rather than focusing pointedly and sometimes exclusively on post traumatic distress disorder, although these conditions often overlap considerably…and cannot be studied, treated or understood in isolation,” James C. Jackson, PsyD, and colleagues concluded.

In a commentary on the study, pulmonologists Hallie C. Prescott, MD, and Theodore J. Iwashyna, MD, PhD, examined the significance of the research.

“When depression manifests as physical symptoms, patients are less likely to receive a diagnosis,” they wrote. “If they are diagnosed, they are less likely to respond to treatment. In patients with cardiovascular disease, somatic symptoms of depression (but not cognitive symptoms) are associated with worsened long-term outcomes, including mortality and readmission to hospital …. By differentiation of depression into cognitive and physical components, Jackson and colleagues have provided an important step towards tailoring of future interventions to specific symptoms subsets and not the generic diagnosis of depression,” they wrote.

Disclosures: See the full study for a complete list of relevant financial disclosures.