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在重症监护病房长时间停留后的患者的心理健康护理利用的比率和预测因素:一项前瞻性队列研究。

Rates and predictors of mental health care utilisation in patients following a prolonged stay on intensive care unit: a prospective cohort study.

机构信息

Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

出版信息

BMJ Open. 2023 Jan 24;13(1):e063468. doi: 10.1136/bmjopen-2022-063468.

Abstract

OBJECTIVES

An acute critical illness and secondary complications may necessitate a prolonged treatment on an intensive care unit (ICU). As long-term consequences, ICU survivors may suffer from both physical and psychological sequelae. To improve the aftercare of these patients, the present study aimed to assess the use of mental healthcare and associated factors following prolonged ICU stay.

METHODS

N=197 patients with a primary diagnosis of critical illness polyneuropathy/myopathy were enrolled within 4 weeks (T1) and interviewed three (T2) and six (T3) months following the transfer from acute-care to postacute ICU. Symptoms and a current diagnosis of major depression/post-traumatic stress disorder (PTSD) were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The potential need for mental healthcare, its current and past use and reasons for non-use were raised.

RESULTS

Full syndromal and subsyndromal major depression/PTSD were diagnosed in 8.3%/15.6% at T2, 12.2%/23.5% at T3. About 29% of the patients reported mental healthcare utilisation. Considering somatic complaints, more important was a common reason for the non-use of mental healthcare. Female gender, previous mental healthcare, number of sepsis episodes and pension receipt increased the chance for mental healthcare utilisation, a pre-existing mental disorder decreased it.

CONCLUSION

Every fourth patient surviving prolonged ICU treatement makes use of mental healthcare . Particularly male patients with pre-existing mental disorders should be targeted preventively, receiving specific psychoeducation about psychological long-term sequelae and mental healthcare options post-ICU.Trial registration numberDRKS00003386.

摘要

目的

急性危重病和继发并发症可能需要在重症监护病房(ICU)接受长时间治疗。作为长期后果,ICU 幸存者可能会遭受身体和心理后遗症。为了改善这些患者的后续护理,本研究旨在评估 ICU 长时间停留后精神保健的使用情况及其相关因素。

方法

在急性治疗后转入急性 ICU 后 4 周(T1)、3 个月(T2)和 6 个月(T3)内,共纳入 197 名患有危重病多发性神经病/肌病的患者。使用《精神障碍诊断与统计手册》的结构临床访谈评估症状和当前的重度抑郁症/创伤后应激障碍(PTSD)诊断。提出了对精神保健的潜在需求、其当前和过去的使用情况以及未使用的原因。

结果

在 T2 时,完全综合征和亚综合征重度抑郁症/PTSD 的诊断率分别为 8.3%/15.6%,T3 时分别为 12.2%/23.5%。约 29%的患者报告了精神保健的使用情况。考虑到躯体主诉,更重要的是未使用精神保健的常见原因。女性性别、以前的精神保健、败血症发作次数和养老金领取增加了精神保健使用的机会,而先前存在的精神障碍则降低了这种机会。

结论

每四个接受长时间 ICU 治疗的患者中就有一个会使用精神保健。特别是有先前精神障碍的男性患者应作为预防目标,接受关于 ICU 后心理长期后果和精神保健选择的特定心理教育。试验注册号 DRKS00003386。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d28b/9884925/79a33e70a15c/bmjopen-2022-063468f01.jpg

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