A third of intensive care patients develop depression that typically manifests as physical, or somatic, symptoms such as weakness, appetite change, and fatigue, rather than psychological symptoms.
This is the finding of one of the largest studies to investigate the mental health and functional outcomes of survivors of critical care.
The US study, published in the journal Lancet Respiratory Medicine, suggests ICU survivors could be three times more likely to experience depression than the general population, and that depression is four times more common than post-traumatic stress disorder after critical illness.
“We need to determine how best to enhance recovery with a new focus on physical and occupational rehabilitation”
“It’s a significant public health issue”, said lead study author Dr James Jackson, psychologist and assistant professor of medicine at Vanderbilt University Medical Center.
“We need to pay more attention to preventing and treating the physical rather than psychological symptoms of depression in ICU survivors,” he said.
He added: “The physical symptoms of depression are often resistant to standard treatment with antidepressant drugs and we need to determine how best to enhance recovery with a new focus on physical and occupational rehabilitation.”
The study observed 821 critically ill patients with respiratory failure or severe sepsis admitted to medical or surgical ICUs. The researchers used neuropsychological tests to assess survivors at three months and 12 months for depression, PTSD, functional disability, and impact on quality of life.
The researchers found 37% of the 406 patients assessed at three months had at least mild depression—two-thirds due largely to physical rather than psychological symptoms. A third of the survivors who developed depression still had depressive symptoms at their 12 month assessment.
While depressive symptoms were more likely to occur in patients with pre-existing depression, it was also found to be common in those without any psychiatric history.
In contrast, only 7% of patients experienced symptoms of PTSD.
The authors also noted that patients of all ages had high rates of disability in basic activities of daily living – inability to eat, bath, and dress without assistance.
High rates of disability in instrumental activities of daily living – ability to manage money, make travel plans, make a complex shopping list, or follow a recipe – were also observed.
“These rates are worse than those seen in people with mild dementia”, said Dr Jackson.
“Substantial time and energy has been invested in addressing PTSD in survivors of critical illness, but our findings suggest that it is less pervasive than depression,” he said.