Recovering from trauma and a lengthy ICU stay might make some people depressed. But their depression may not display itself as one might expect, a new study has found.
Many of these patients' symptoms were physical, the study found. Those recovering from a serious illness and time in the ICU were often tired, had no appetite and felt weak.
In addition, although the rate of post-traumatic stress disorder (PTSD) was lower than expected in this group, the researchers noted it was still double that of its rate in the general population.
This study was led by James Jackson, PsyD, assistant professor of medicine at Vanderbilt School of Medicine in Nashville, TN.
The researchers enrolled 836 patients between March 2007 and June 2010. All were in the ICU at Vanderbilt or Saint Thomas Hospital, also in Nashville. These patients were 18 years or older and mainly had respiratory failure, sepsis (blood infection) or shock (a condition in which the body is not getting enough blood flow).
The patients were seen in hospital, and then were assessed at three months and 12 months after being discharged from the hospital by interviewers who went to their homes. They were given several tests meant to assess how well they were doing with activities of daily living, to check for depression and PTSD and to find out what issues they were coping with related to their trauma and hospital stay.
Many patients in the original group were lost in follow-up; several died and others dropped out of the study.
At three-months after their hospital stay, 30 percent reported depressive symptoms (76 of 255 patients). At 12 months, this was true for 29 percent (62 of 217 people).
Seven percent of all patients had signs of PTSD at both follow-up points.
By 12 months, 23 percent of patients still had difficulty with activities of daily living, such as feeding, bathing or dressing.
The study authors noted that depression was five times more common than PTSD in ICU survivors. Symptoms of depression tended not to be cognitive (related to sadness or guilt, for example). Rather, the symptoms of depression among ICU survivors were somatic (physical symptoms related to loss of appetite, weakness or fatigue). Two-thirds of patients had somatic symptoms, the authors reported.
They also found that patients who were delirious in the hospital (those who had a short period of confusion) did not have any long-term negative consequences as a result.
Furthermore, the researchers found that depression and PTSD were as common among the younger survivors as they were in older folks. Age did not seem to matter.
Many of the survivors showed physical disability at the follow-up, and this may be related to their somatic symptoms of depression, the authors noted.
“This finding suggests that physical disability contributes predominantly to this depression, which has implications for the roles of physical rehabilitation versus anti-depressant medications in the prevention and management of depression after ICU admission,” the authors wrote in their conclusion.
In a separate editorial, Hallie Prescott and Theodore Iwashyna, of the Department of Medicine at the University of Michigan, wrote, “The predominance of physical over cognitive symptoms of depression also raises the question of what exactly is being measured: mental or physical illness? Many of the somatic symptoms of depression could result from decreased muscle mass and other comorbid medical illnesses that are common in survivors of the intensive-care unit."
There need to be more interventions in rehabilitation that can help these patients, the editorial authors noted. “By differentiation of depression into cognitive and physical components, Jackson and colleagues have provided an important step towards tailoring of future interventions to specific symptoms subsets, and not the generic diagnosis of depression," they wrote.
This study appeared online April 7 in The Lancet Respiratory Medicine.
The study's authors noted several potential conflicts of interest, including funding for non-promotional purposes from various pharmaceutical companies.