Dr Robert Hatch is a Specialist Registrar in Anaesthetics and Intensive Care Medicine in the Oxford Deanery. In addition to being a clinician, his research interests include long-term outcomes and rehabilitation after critical illness and the use of health care data to improve the quality of patient care. Here he describes the Intensive Care Outcomes Network (ICON) study. This is a UK multi-centre study funded by the Intensive Care Society and the BUPA Foundation.
ICON involved 26 varied UK Intensive Care Units (ICUs) and nearly thirteen thousand patients. The study aimed to describe health related quality of life and the prevalence of psychological symptoms amongst survivors of Intensive Care. The paper describes the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) after discharge from the ICU. Patients completed questionnaires containing the Hospital Anxiety and Depression Scale (HADS) and the PTSD Checklist – Civilian version (PCL-C).
Over half of those who responded reported significant symptoms of anxiety, depression or PTSD. When significant symptoms did occur, there was a 65% chance that they co-occurred with symptoms of one or more of the other two conditions. Thresholds for all three conditions simultaneously were met in 17% of responders. Interestingly PTSD was very unlikely to occur in isolation (1% of respondents).
In otherwise similar patients, those reporting symptoms of depression were 47% more likely to die from any cause (all-cause mortality) during the first two years after discharge from the ICU than those who did not report these symptoms.
The results should be interpreted with caution as all participants were in the United Kingdom and less than 40% of those invited took part1. However, the results suggest clinicians should consider depression following care of a critical illness a marker of declining health. In addition, we should be aware that psychopathology is often complex with overlapping conditions in these patients.
1. Hatch R, Young D, Barber V, Harrison DA, Watkinson P. The effect of postal questionnaire burden on response rate and answer patterns following admission to intensive care: a randomised controlled trial.BMC Med Res Methodol. 2017;17(1). doi:10.1186/s12874-017-0319-3
Dr Hatch is currently funded by an NIHR Academic Clinical Fellowship in Intensive Care Medicine