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Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis

Rabiee, Anahita MD; Nikayin, Sina MD; Hashem, Mohamed D. MD; Huang, Minxuan ScM; Dinglas, Victor D. MPH; Bienvenu, O. Joseph MD, PhD; Turnbull, Alison E. DVM, MPH, PhD; Needham, Dale M. FCPA, MD, PhD

doi: 10.1097/CCM.0000000000001811
Neurologic Critical Care
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Objectives: To synthesize data on prevalence, natural history, risk factors, and post-ICU interventions for depressive symptoms in ICU survivors.

Data Sources: PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry (1970–2015).

Study Selection: Studies measuring depression after hospital discharge using a validated instrument in more than 20 adults from non-specialty ICUs.

Data Extraction: Duplicate independent review and data abstraction.

Data Synthesis: The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n = 4,113). The Hospital Anxiety and Depression Scale-Depression subscale was used most commonly (58%). The pooled Hospital Anxiety and Depression Scale-Depression subscale prevalence (95% CI) of depressive symptoms at a threshold score greater than or equal to 8 was 29% (22–36%) at 2–3 months (12 studies; n = 1,078), 34% (24–43%) at 6 months (seven studies; n = 760), and 29% (23–34%) at 12–14 months (six studies; n = 1,041). The prevalence of suprathreshold depressive symptoms (compatible with Hospital Anxiety and Depression Scale-Depression subscale, ≥ 8) across all studies, using all instruments, was between 29% and 30% at all three time points. The pooled change in prevalence (95% CI) from 2–3 to 6 months (four studies; n = 387) was 5% (–1% to +12%), and from 6 to 12 months (three studies; n = 412) was 1% (–6% to +7%). Risk factors included pre-ICU psychologic morbidity and presence of in-ICU psychologic distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms.

Conclusions: Clinically important depressive symptoms occurred in approximately one-third of ICU survivors and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.

Supplemental Digital Content is available in the text.

1Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

2Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.

3Department of Psychiatry and Behavior Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD.

4Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

5Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the National Heart, Lung, and Blood Institute (R24HL111895).

Dr. Rabiee received support for article research from the National Institutes of Health (NIH). Her institution received grant support from the National Heart, Lung, and Blood Institute (NHLBI) (R24HL111895). Dr. Nikayin received support for article research from the NIH. His institution received grant support from the NHLBI (R24HL111895). Dr. Hashem received support for article research from the NIH. His institution received grant support from the NHLBI (R24HL111895). Dr. Dinglas received support for article research from the NIH. Dr. Bienvenu received support for article research from the NIH. His institution received funding from the NHLBI. Dr. Turnbull received support for article research from the NIH. Her institution received grant support from the NIH (NHLBI). Dr. Needham received support for article research from the NIH. His institution received grant support from the NIH. Dr. Huang disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: dale.needham@jhmi.edu

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