Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study.
Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study.
复制标题
DOI：
10.1016/s2213-2600(14)70051-7
复制
发表时间：
2014-05
影响因子：
76.2
通讯作者：
Ely, E. Wesley
中科院分区：
文献类型：
--
作者：
Jackson, James C.;Pandharipande, Pratik P.;Girard, Timothy D.;Brummel, Nathan E.;Thompson, Jennifer L.;Hughes, Christopher G.;Pun, Brenda T.;Vasilevskis, Eduard E.;Morandi, Alessandro;Shintani, Ayumi K.;Hopkins, Ramona O.;Bernard, Gordon R.;Dittus, Robert S.;Ely, E. Wesley
危重疾病与认知功能障碍有关，但一般重症监护病房(ICU)幸存者的心理健康和功能障碍的特征并不充分，关于年龄和精神错乱之间的关系以及这些结果的数据也很少。在这项前瞻性的多点队列研究中，我们招募了患有呼吸衰竭或休克的内科/外科ICU患者，收集了详细的人口统计数据和医院内变量，并用抑郁、创伤后应激障碍(PTSD)和功能残疾的测量来评估3个月和12个月的幸存者。我们使用线性和比例优势Logistic回归来检验年龄和精神障碍持续时间与精神健康和功能障碍之间的独立关联。我们招募了821名患者，中位年龄61岁(51，71岁)，分别在出院后3个月和12个月评估了448名患者和382名患者。在3个月和12个月的随访中，37%(149/407)和33%(116/347)的受试者报告至少有轻度抑郁，主要是由躯体症状而不是认知症状驱动的。抑郁症状甚至在那些没有报告抑郁病史的人中也很常见，这些人中分别有30%(76/255)和29%(62/217)报告了3个月和12个月的随访。在任何一项后续评估中，只有7%(27/415，24/361)的受试者有与创伤后应激障碍相一致的症状。3个月时32%(139/428)和26%(108/422)存在日常生活基本活动(ADL)和工具性日常生活活动(IADL)障碍，12个月时分别为27%(102/374)和23%(87/372)。心理健康和功能障碍在青年和老年患者中普遍存在。虽然老年经常与精神健康和功能障碍有关，但在精神错乱和这些结果之间没有观察到一致的联系。与早期的单中心报告不同，这项大型多中心研究的数据显示，危重疾病后抑郁比创伤后应激障碍更常见，而且驱动因素是身体残疾的躯体症状，而不是认知症状。精神健康状况不佳和功能残疾很常见，而且在高达四分之一的患者中持续存在。
Critical illness is associated with cognitive impairment, but mental health and functional disabilities in general intensive care unit (ICU) survivors are inadequately characterized and there are a paucity of data regarding the relationship between age and delirium and these outcomes. In this prospective, multisite cohort study, we enrolled medical/surgical ICU patients with respiratory failure or shock, collected detailed demographics and in-hospital variables, and assessed survivors at 3 and 12 months with measures of depression, posttraumatic stress disorder (PTSD) and functional disability. We used linear and proportional odds logistic regression to examine the independent associations between age and delirium duration versus mental health and functional disabilities. We enrolled 821 patients with a median (interquartile range) age of 61 (51, 71), assessing 448 patients and 382 patients 3 and 12 months after discharge. At 3- and 12-month follow-up, 37% (149/407) and 33% (116/347) of subjects reported at least mild depression, driven primarily by somatic rather than cognitive symptoms. Depressive symptoms were common even among those with no proxy reported history of depression, reported at 3- and 12-month follow-up by 30% (76/255) and 29% (62/217) of these individuals. At either follow-up assessment, only 7% (27/415, 24/361) of subjects had symptoms consistent with PTSD. Disabilities in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were present in 32% (139/428) and 26% (108/422) of individuals at 3 months and in 27% (102/374) and 23%(87/372) at 12 months. Mental health and functional difficulties were prevalent in young and old patients. Although older age was frequently associated with mental health and functional disabilities, no consistent association was observed between delirium and these outcomes. In contrast with early single-center reports, data from this large, multicenter investigation reveal depression is much more common than PTSD after critical illness and is driven by somatic symptoms indicative of physical disabilities rather than by cognitive symptoms. Poor mental health and functional disability were common, and persistent in up to a quarter of patients.