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Mental illness after admission to an intensive care unit

Intensive Care Medicine volume 45, pages 1550–1558 (2019)Cite this article

Abstract

Purpose

Survivors of critical illness may be at higher risk of developing subsequent mental illness. We sought to determine the risk of new mental illness diagnoses across a large population of intensive care unit (ICU) survivors compared with hospitalized patients.

Methods

Population-based study (2005–2015) conducted in adults hospitalized in Ontario, Canada. The primary exposure was ICU admission for ≥ 48 h; secondary exposures were ICU procedures including mechanical ventilation and duration of ICU. The primary outcome was mental illness diagnosed during the year after hospital discharge. To account for case mix differences between ICU and other hospitalized patients, sensitivity analyses were conducted restricting to six pre-specified diagnoses that can lead to hospitalization with or without ICU.

Results

1,847,462 patients survived hospitalization, of whom 121,101 were admitted to ICU for ≥ 48 h. ICU patients had a higher rate of new mental illness diagnoses in the year after discharge compared to hospitalized patients (17 vs. 15%, adjusted hazard ratio (aHR) 1.08, 95% CI 1.07–1.10). In analyses restricted to pre-specified most responsible diagnoses, the increased risk associated with ICU was only significant for patients with pneumonia. Among ICU survivors, exposure to mechanical ventilation (aHR: 1.08; 95% CI 1.05–1.12) or longer ICU stays (aHR: 1.004 per day; 95% CI 1.003–1.005) increased the risk of new mental illness diagnosis.

Conclusions

ICU was associated with a marginally increased risk of mental illness diagnosis after hospitalization that was often no longer apparent when reason for admission was considered. Patients exposed to mechanical ventilation or longer ICU stays may be at higher risk of subsequent mental illnesses.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Author information

Authors and Affiliations

  1. Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Lavarnan Sivanathan, Hannah Wunsch, Simone Vigod & Damon C. Scales

  2. Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada

    Lavarnan Sivanathan & Hannah Wunsch

  3. ICES, Toronto, ON, Canada

    Hannah Wunsch, Simone Vigod & Damon C. Scales

  4. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Hannah Wunsch & Damon C. Scales

  5. Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada

    Hannah Wunsch, Andrea Hill, Ruxandra Pinto & Damon C. Scales

  6. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Simone Vigod

  7. Department of Psychiatry, Women’s College Hospital, Toronto, ON, Canada

    Simone Vigod

  8. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Damon C. Scales

  9. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Damon C. Scales

Authors
  1. Lavarnan Sivanathan
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  2. Hannah Wunsch
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  3. Simone Vigod
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  4. Andrea Hill
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  5. Ruxandra Pinto
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  6. Damon C. Scales
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Contributions

Conception of Study: LS, HW, SV, DCS. Design of Study: LS, HW, SV, DCS. Analytical Plan/Analyses: LS, HW, SV, AH, RP, DCS. Supervision: HW, SV, DCS. Editing of Manuscript for Intellectual Content: LS, HW, SV, AH, RP, DCS.

Corresponding author

Correspondence to Lavarnan Sivanathan.

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Conflicts of interest

Dr. Vigod receives royalties from UpToDate Inc. for authorship of materials related to depression and pregnancy. Other authors have no commercial or financial conflicts of interest to declare.

Ethics approval

This study was approved by the Research Ethics Board of Sunnybrook Health Sciences Center and the University of Toronto Office of Research Ethics.

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Cite this article

Sivanathan, L., Wunsch, H., Vigod, S. et al. Mental illness after admission to an intensive care unit. Intensive Care Med 45, 1550–1558 (2019). https://doi.org/10.1007/s00134-019-05752-5

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  • DOI: https://doi.org/10.1007/s00134-019-05752-5

Keywords

  • Post intensive care syndrome
  • Critical illness
  • Depression
  • Anxiety
  • Hospitalization