Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study

Mika Hamilton; George Tomlinson; Leslie Chu; Priscila Robles; Andrea Matte; Stacey Burns; Claire Thomas; Francois Lamontagne; Neill K J Adhikari; Niall Ferguson; Jan O Friedrich; Jill C Rudkowski; Yoanna Skrobik; Hilary Meggison; Jill Cameron; Margaret Herridge; RECOVER Program Investigators; Canadian Critical Care Trials Group

doi:10.1016/j.chest.2019.04.104

Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study

Chest. 2019 Sep;156(3):466-476. doi: 10.1016/j.chest.2019.04.104. Epub 2019 May 15.

Authors

Mika Hamilton¹, George Tomlinson², Leslie Chu³, Priscila Robles⁴, Andrea Matte³, Stacey Burns³, Claire Thomas³, Francois Lamontagne⁵, Neill K J Adhikari⁶, Niall Ferguson⁷, Jan O Friedrich⁸, Jill C Rudkowski⁹, Yoanna Skrobik¹⁰, Hilary Meggison¹¹, Jill Cameron¹², Margaret Herridge⁷; RECOVER Program Investigators; Canadian Critical Care Trials Group

Collaborators

Margaret S Herridge, Leslie M Chu, Andrea Matte, George Tomlinson, Linda Chan, Claire Thomas, Jan O Friedrich, Sangeeta Mehta, Francois Lamontagne, Melanie Levasseur, Niall D Ferguson, Neill K J Adhikari, Jill C Rudkowski, Hilary Meggison, Yoanna Skrobik, John Flannery, Mark Bayley, Jane Batt, Claudia Dos Santos, Susan E Abbey, Adrienne Tan, Vincent Lo, Sunita Mathur, Matteo Parotto, Denise Morris, Linda Flockhart, Eddy Fan, Christie M Lee, M Elizabeth Wilcox, Najib Ayas, Karen Choong, Robert Fowler, Damon C Scales, Tasnim Sinuff, Brian H Cuthbertson, Louise Rose, Priscila Robles, Stacey Burns, Marcelo Cypel, Lianne Singer, Cecelia Chaparro, Chung-Wai Chow, Shaf Keshavjee, Laurent Brochard, Paul Hebert, Arthur S Slutsky, John C Marshall, Deborah Cook, Jill I Cameron

Affiliations

¹ Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
² Department of Medicine, University Health Network and Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
⁵ Centre de recherché du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.
⁶ Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁷ Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada.
⁸ Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Departments of Medicine and Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁹ Departments of General Internal Medicine and Critical Care, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Medicine, Division of Critical Care, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, QC, Canada.
¹¹ Department of Critical Care, University of Ottawa, Ottawa, ON, Canada.
¹² Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada.

PMID: 31102611
DOI: 10.1016/j.chest.2019.04.104

Abstract

Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms.

Methods: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months.

Results: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score ≥ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P = .007), and incomplete secondary education (by 3.8 BDI-II points; P = .009); a curvilinear relation with age (P = .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P = .92), sex (P = .25), ICU LOS (P = .51), or caregiver variables (Caregiver Assistance Scale [P = .28] and Center for Epidemiologic Studies Depression Scale [P = .74]).

Conclusions: Increased functional dependence, lower income, and lower education are associated with increased severity of post-ICU depressive symptoms, whereas age has a curvilinear relation with symptom severity. Knowledge of risk factors may inform surveillance and targeted mental health follow-up. Early mobilization and rehabilitation aiming to improve function may serve to modify mood disorders.

Keywords: critical care; depression; exercise; health-related quality of life; rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Canada
Caregivers
Cohort Studies
Critical Care*
Depression / diagnosis
Depression / epidemiology*
Female
Humans
Length of Stay
Male
Middle Aged
Motor Activity
Patient Discharge*
Recovery of Function
Respiration, Artificial*
Risk Factors
Socioeconomic Factors
Time Factors

Grants and funding

CIHR/Canada