Wang Sophia, Mosher Chris, Perkins Anthony J, Gao Sujuan, Lasiter Sue, Khan Sikandar, Boustani Malaz, Khan Babar
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Roudebush VA Medical Center, Indianapolis, Indiana, USA.
J Hosp Med. 2017 Oct;12(10):831-835. doi: 10.12788/jhm.2827. Epub 2017 Sep 6.
The prevalence of psychiatric symptoms ranges from 17% to 44% in intensive care unit (ICU) survivors. The relationship between the comorbidity of psychiatric symptoms and quality of life (QoL) in ICU survivors has not been carefully examined. This study examined the relationship between psychiatric comorbidities and QoL in 58 survivors of ICU delirium. Patients completed 3 psychiatric screens at 3 months after discharge from the hospital, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for anxiety, and the Post-Traumatic Stress Syndrome (PTSS- 10) questionnaire for posttraumatic stress disorder. Patients with 3 positive screens (PHQ-9 = 10; GAD-7 = 10; and PTSS-10 > 35) comprised the high psychiatric comorbidity group. Patients with 1 to 2 positive screens were labeled the low to moderate (low-moderate) psychiatric comorbidity group. Patients with 3 negative screens were labeled the no psychiatric morbidity group. Thirty-one percent of patients met the criteria for high psychiatric comorbidity. After adjusting for age, gender, Charlson Comorbidity Index, discharge status, and prior history of depression and anxiety, patients who had high psychiatric comorbidity were more likely to have a poorer QoL compared with the low-moderate comorbidity and no morbidity groups, as measured by a lower EuroQol 5 dimensions questionnaire 3-level Index (no, 0.69 ± 0.25; low-moderate, 0.70 ± 0.19; high, 0.48 ± 0.24; P = 0.017). Future studies should confirm these findings and examine whether survivors of ICU delirium with high psychiatric comorbidity have different treatment needs from survivors with lower psychiatric comorbidity.
重症监护病房（ICU）幸存者中精神症状的患病率在17%至44%之间。ICU幸存者中精神症状合并症与生活质量（QoL）之间的关系尚未得到仔细研究。本研究调查了58名ICU谵妄幸存者中精神合并症与生活质量之间的关系。患者在出院后3个月完成了3项精神筛查，包括用于评估抑郁的患者健康问卷-9（PHQ-9）、用于评估焦虑的广泛性焦虑障碍问卷-7（GAD-7）以及用于评估创伤后应激障碍的创伤后应激综合征问卷（PTSS-10）。三项筛查均呈阳性（PHQ-9 = 10；GAD-7 = 10；PTSS-10 > 35）的患者组成高精神合并症组。有1至2项筛查呈阳性的患者被标记为低至中度精神合并症组。三项筛查均为阴性的患者被标记为无精神疾病组。31%的患者符合高精神合并症标准。在调整年龄、性别、Charlson合并症指数、出院状态以及既往抑郁和焦虑病史后，与低至中度合并症组和无疾病组相比，高精神合并症患者的生活质量更差，这通过较低的欧洲五维健康量表3级指数来衡量（无疾病组，0.69±0.25；低至中度组，0.70±0.19；高合并症组，0.48±0.24；P = 0.017）。未来的研究应证实这些发现，并研究ICU谵妄高精神合并症幸存者与低精神合并症幸存者是否有不同的治疗需求。
