Teixeira Cassiano, Rosa Regis Goulart, Sganzerla Daniel, Sanchez Evelin C, Robinson Caroline Cabral, Dietrich Camila, Kochhann Renata, de Souza Denise, Rech Gabriela S, da R Dos Santos Rosa, Schneider Daniel, Boldo Rodrigo, Sharshar Tarek, Bozza Fernando Augusto, Falavigna Maicon, Friedman Gilberto
Post-graduation of Pulmonology-Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil.
Chest. 2021 Jul;160(1):157-164. doi: 10.1016/j.chest.2021.02.034. Epub 2021 Feb 25.
Survivors of critical care may demonstrate mental health disorders in the months after discharge.
What are risk factors for mental health disorders after ICU discharge and is there an association between the burden of mental illness and health-related quality of life (HRQoL)?
Multicenter prospective cohort study that included 579 adult ICU survivors with an ICU stay of > 72 h in 10 ICUs.
The outcomes were anxiety and depression assessed by the Hospital Anxiety and Depression Scale, posttraumatic stress disorder (PTSD) assessed by the Impact Event Scale 6, and HRQoL assessed by the Short Form 12 version 2. The 6-month prevalences of any mental health disorder were 36.2% (the prevalences of anxiety, depression, and PTSD were 24.2%, 20.9%, and 15.4%, respectively). ICU survivors with mental health disorders showed worse HRQoL scores in both physical and mental dimensions than those without. The higher the number of psychiatric syndromes manifested, the worse the mental dimension of HRQoL. Age of < 65 years (P = .009), history of depression (P = .009), anxiety (P = .003) and depression (P = .02) symptoms at ICU discharge, physical dependence (P = .01), and decreased physical functional status (P = .04) at 6 months were associated with anxiety. History of depression (P = .001), depression symptoms at ICU discharge (P < .001), and decreased physical functional status at 6 months (P = .01) were associated with depression. Depression symptoms at ICU discharge (P = .01), physical dependence (P = .01), and decreased physical functional status (P = .02) at 6 months were associated with PTSD.
The network of potential risk factors for mental illness among patients discharged from an ICU is complex and involves multiple factors (age, premorbid mental health, acute emotional stress, and physical impairment after ICU stay). The negative impact of the burden of mental illness on HRQoL among critical care survivors is of concern.
危重症幸存者在出院后的数月内可能会出现精神健康障碍。
重症监护病房（ICU）出院后精神健康障碍的风险因素有哪些，以及精神疾病负担与健康相关生活质量（HRQoL）之间是否存在关联？
多中心前瞻性队列研究，纳入了10个ICU中579名成年ICU幸存者，其ICU住院时间>72小时。
通过医院焦虑抑郁量表评估焦虑和抑郁，通过冲击事件量表6评估创伤后应激障碍（PTSD），通过简明健康调查量表12版2评估HRQoL。任何精神健康障碍的6个月患病率为36.2%（焦虑、抑郁和PTSD的患病率分别为24.2%、20.9%和15.4%）。患有精神健康障碍的ICU幸存者在身体和精神维度上的HRQoL得分均低于未患精神健康障碍的幸存者。表现出的精神综合征数量越多，HRQoL的精神维度越差。年龄<65岁（P = 0.009）、ICU出院时的抑郁史（P = 0.009）、焦虑（P = 0.003）和抑郁（P = 0.02）症状、身体依赖（P = 0.01）以及6个月时身体功能状态下降（P = 0.04）与焦虑相关。抑郁史（P = 0.001）、ICU出院时的抑郁症状（P < 0.001）以及6个月时身体功能状态下降（P = 0.01）与抑郁相关。ICU出院时的抑郁症状（P = 0.01）、身体依赖（P = 0.01）以及6个月时身体功能状态下降（P = 0.02）与PTSD相关。
ICU出院患者中精神疾病潜在风险因素的网络很复杂，涉及多个因素（年龄、病前精神健康状况、急性情绪应激以及ICU住院后的身体损伤）。精神疾病负担对危重症幸存者HRQoL的负面影响值得关注。
