Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness
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Some patients who survive intensive care unit (ICU) treatment report psychological sequelae during recovery. This study examined factors associated with psychological outcomes of former ICU patients up to 6 months after hospital discharge.
Participants (n = 195) were adult survivors of ICU enrolled in a multicenter trial of physical rehabilitation after hospital discharge. The 36-Item Short-Form Health Survey (SF-36), the Impact of Events Scale (IES) and the Depression, Anxiety and Stress Scales were completed, and sleep rated on a five-point scale at weeks 1, 8 and 26; clinical and demographic data were obtained from patient records.
Participants were 41% females with mean ± standard deviation (SD) age of 57 ± 16 years and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 19 ± 7; median lengths of mechanical ventilation and ICU stay were 89 h and 6 days, respectively. Impaired mental health, depression, anxiety, stress and psychological distress significantly improved after week 1. Female gender, younger age and sleeping problems were associated with impaired psychological outcomes on bivariate analyses. Age; gender; week 1 anxiety, depression and stress; week 26 sleeping; and rehabilitation study group were entered into multiple linear regression analyses for week 26 IES and SF-36 Mental Component Summary (MCS) outcomes. IES scores were associated (p < 0.05) with gender, week 1 stress and week 26 sleep but not study group; MCS scores were associated (p < 0.05) with week 1 stress and week 26 sleep but not study group.
Female gender, early levels of increased stress and problems sleeping are associated with worse psychological recovery for survivors of critical illness.
KeywordsCritical illness Intensive care Mental health Psychological distress Sleep
The authors acknowledge Penny Taylor for study coordination, screening and enrollment of patients and data collection; Rachel Foley, Selina Hole, David Wastell, Mary Fien, Anne Limpic, Mary Maxwell, Eleanor Rose, Jacelle Lang, Lydia Gawa and Teresa Williams for screening and enrollment of patients and data collection; Dena Hogben, Marianne O’Reilly, Kylie Leach, Ashley Job, Nicohle Kenney, Jennie King, Jacquie Hyslop, Sheridan Hatter, Leonie Weisbrodt, Debbie Carney, Leanne Jack, Renae Deans, Claire Bertenshaw, Janine Stuart, Melissa Lassig-Smith, Mary Nolan and Leeona Smith for screening and enrollment of patients; Jill Dent, Monika Fluckiger, Elizabeth Robertson, Sally Cumming, Renee Subacius and Belinda Green for data collection; Linda Parker, Ann Tully, Shane Patman, Meagan Jerome, Tenille Ricketts and Amanda Simmonds for provision of the study intervention; and Phillip Johnson for assistance with database construction. This study was funded by National Health and Medical Research Council project grant no. 352407.
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