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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31819fea55
Clinical Investigations

Are intensive care factors associated with depressive symptoms 6 months after acute lung injury?*

Dowdy, David W. MD, PhD; Bienvenu, Oscar Joseph MD, PhD; Dinglas, Victor D. BS; Mendez-Tellez, Pedro A. MD; Sevransky, Jonathan MD; Shanholtz, Carl MD; Needham, Dale M. MD, PhD

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Abstract

Objective: To evaluate intensive care–related factors as predictors of depressive symptoms 6 months after acute lung injury (ALI).

Design: Prospective cohort study.

Setting: Thirteen intensive care units (ICUs) in four hospitals in Baltimore, MD.

Patients: Consecutive ALI survivors (n = 160; 71% from medical ICUs) screened for depressive symptoms at 6 months post-ALI.

Interventions: None.

Measurements and Main Results: We prospectively measured 12 features of critical illness and ICU care and used multivariable regression to evaluate associations with depressive symptoms as measured by the Hospital Anxiety and Depression Score. The prevalence of a positive screening for depression (score ≥8) at 6 months post-ALI was 26%. Depressive symptoms were significantly associated with surgical (vs. medical or trauma) ICU admission (relative risk [RR] 2.2, 95% confidence interval [CI] 1.1–4.2), maximum daily Sequential Organ Failure Assessment Score of >10 (RR 2.1, 95% CI 1.1–3.5), and mean daily ICU benzodiazepine dose of ≥75 mg of midazolam equivalent (RR 2.1, 95% CI 1.1–3.5).

Conclusions: Depressive symptoms at 6 months post-ALI are common and potentially associated with ICU-related factors. Mechanisms by which critical illness and intensive care management associate with depressive symptoms merit further investigation.

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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