Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis.
Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis.
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DOI：
10.1097/ccm.0000000000001811
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发表时间：
2016-09
影响因子：
8.8
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Rabiee A;Nikayin S;Hashem MD;Huang M;Dinglas VD;Bienvenu OJ;Turnbull AE;Needham DM
综合PubMed、EMBASE、CINAHL、PsycINFO、CENTRAL关于ICU幸存者抑郁症状的患病率、自然史、风险因素和ICU后干预的数据（1970 - 2015）在来自非专科ICU的>20名成人中使用经验证的工具测量出院后抑郁的研究重复独立审查和数据提取检索确定了27，334篇标题，42篇合格文章，涉及38项独特研究（n= 4，113）。医院焦虑和抑郁量表-抑郁子量表（HADS-D）最常用（58%）。合并HADS-D患病率在2-3个月时，阈值评分≥8的抑郁症状发生率（95%置信区间（CI））为29%（22-36%）（12项研究，n= 1，078），6个月时为34%（24-43%）（7项研究，n=760），12-14个月时为29%（23-34%）（6项研究，n= 1，041）。在所有研究中，使用所有工具，所有3个时间点的阈上抑郁症状（与HADS-D≥8相一致）的患病率均在29-30%之间。从2-3个月到6个月（4项研究，n=387）的合并患病率变化（95%CI）为5%（−1%至+12%），从6个月到12个月（3项研究，n=412）为1%（−6%至+7%）。危险因素包括ICU前心理疾病和ICU内心理困扰症状的存在。我们没有发现任何ICU后干预有明显改善抑郁症状的证据。约三分之一的ICU幸存者出现了临床上重要的抑郁症状，并持续到12个月的随访。需要对这种常见和持续的ICU后发病率进行更多的治疗研究。
To synthesize data on prevalence, natural history, risk factors and post-intensive care unit (ICU) interventions for depressive symptoms in ICU survivors PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (1970 – 2015) Studies measuring depression after hospital discharge using a validated instrument in >20 adults from non-specialty ICUs Duplicate independent review and data abstraction 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 (HADS-D), was used most commonly (58%). The pooled HADS-D prevalence (95% confidence interval (CI)) of depressive symptoms at a threshold score ≥8 was 29% (22–36%) at 2–3 months (12 studies, n=1,078), 34% (24–43%) at 6 months, (7 studies, n=760), and 29% (23–34%) at 12–14 months, (6 studies, n=1,041). The prevalence of supra-threshold depressive symptoms (compatible with HADS-D≥8) across all studies, using all instruments, was between 29–30% at all 3 time points. The pooled change in prevalence (95% CI) from 2–3 to 6 months (4 studies, n=387) was 5% (−1% to +12%), and from 6 to 12 months (3 studies, n=412) was 1% (−6% to +7%). Risk factors included pre-ICU psychological morbidity and presence of in-ICU psychological distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms. 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.