Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study
Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study
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DOI：
10.1097/ccm.0000000000001621
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发表时间：
2016-05-01
影响因子：
8.8
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
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作者：
Huang, Minxuan;Parker, Ann M.;Needham, Dale M.
目的：评估急性呼吸窘迫综合征后第一年抑郁、焦虑和创伤后应激障碍症状的患病率、严重程度、共生症状和危险因素。设计：前瞻性纵向队列研究。设置：美国41家急性呼吸窘迫综合征网络医院。患者：698名急性呼吸窘迫综合征幸存者。干预：无。测量和主要结果：使用医院焦虑和抑郁量表和事件影响量表-修订6个月和12个月-评估精神症状。通过泊松和线性回归分别计算调整后的实质性症状患病率(二项结果)和严重程度评分。在12个月期间，在629名患者中，总共有416名(66%)至少有一项精神病学结果测量结果的患者在至少一个领域有实质性症状。在6个月和12个月时，实质性症状的发生率很高且几乎相同(抑郁、焦虑和创伤后应激障碍分别为36%、42%和24%)。最常见的同时出现的模式是同时出现所有三个精神领域的症状。年龄较小、女性、失业、酗酒和在ICU大量使用阿片类药物与精神症状显著相关，而病情严重程度较大和ICU住院时间则不相关。结论：三分之二的急性呼吸窘迫综合征幸存者出现精神症状，且经常并存。在确定恢复期精神症状风险最高的患者时，应考虑社会人口学特征和ICU内阿片类药物的使用，而不是传统的危重疾病严重程度的衡量标准。鉴于急性呼吸窘迫综合征幸存者的高复发率，应同时对其精神后遗症进行全面评估，以最大限度地促进康复。
Objective: To evaluate prevalence, severity, and co-occurrence of and risk factors for depression, anxiety, and posttraumatic stress disorder symptoms over the first year after acute respiratory distress syndrome.Design: Prospective longitudinal cohort study.Settings: Forty-one Acute Respiratory Distress Syndrome Network hospitals across the United States.Patients: Six hundred ninety-eight acute respiratory distress syndrome survivors.Interventions: None.Measurements and Main Results: Psychiatric symptoms were evaluated by using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised at 6 and 12 months. Adjusted prevalence ratios for substantial symptoms (binary outcome) and severity scores were calculated by using Poisson and linear regression, respectively. During 12 months, a total of 416 of 629 patients (66%) with at least one psychiatric outcome measure had substantial symptoms in at least one domain. There was a high and almost identical prevalence of substantial symptoms (36%, 42%, and 24% for depression, anxiety, and posttraumatic stress disorder) at 6 and 12 months. The most common pattern of co-occurrence was having symptoms of all three psychiatric domains simultaneously. Younger age, female sex, unemployment, alcohol misuse, and greater opioid use in the ICU were significantly associated with psychiatric symptoms, whereas greater severity of illness and ICU length of stay were not associated.Conclusions: Psychiatric symptoms occurred in two thirds of acute respiratory distress syndrome survivors with frequent co-occurrence. Sociodemographic characteristics and in-ICU opioid administration, rather than traditional measures of critical illness severity, should be considered in identifying the patients at highest risk for psychiatric symptoms during recovery. Given high co-occurrence, acute respiratory distress syndrome survivors should be simultaneously evaluated for a full spectrum of psychiatric sequelae to maximize recovery.