Kendiss Olafson1, Ruth Ann Marrie2,3, James M Bolton3,4,5, Charles N Bernstein2, O Joseph Bienvenu6, Maia S Kredentser7, Sarvesh Logsetty4,8, Dan Chateau9, Yao Nie10, Marcus Blouw2, Tracie O Afifi3,4, Murray B Stein11,12, William D Leslie2, Laurence Y Katz4, Natalie Mota4,7, Renée El-Gabalawy4,5,7,13, Murray W Enns4, Christine Leong14, Sophia Sweatman15, Jitender Sareen3,4,5. 1. Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada. kolafson@hsc.mb.ca. 2. Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada. 3. Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 4. Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 5. Department of Psychology, University of Manitoba, Winnipeg, MB, Canada. 6. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 8. Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 9. Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia. 10. Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 11. University of California San Diego, La Jolla, CA, USA. 12. VA San Diego Healthcare System, San Diego Healthcare System, San Diego, CA, USA. 13. Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 14. Rady Faculty of Health Sciences, College of Pharmacy, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 15. Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, ON, Canada.
Abstract
PURPOSE: The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. METHODS: Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. RESULTS: The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time × Group interactions). CONCLUSIONS: During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study.
PURPOSE: The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. METHODS: Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. RESULTS: The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time × Group interactions). CONCLUSIONS: During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study.
Authors: O Joseph Bienvenu; Lisa Aronson Friedman; Elizabeth Colantuoni; Victor D Dinglas; Kristin A Sepulveda; Pedro Mendez-Tellez; Carl Shanholz; Peter J Pronovost; Dale M Needham Journal: Intensive Care Med Date: 2017-12-26 Impact factor: 17.440
Authors: Sina Nikayin; Anahita Rabiee; Mohamed D Hashem; Minxuan Huang; O Joseph Bienvenu; Alison E Turnbull; Dale M Needham Journal: Gen Hosp Psychiatry Date: 2016-08-28 Impact factor: 3.238
Authors: Mayur B Patel; James C Jackson; Alessandro Morandi; Timothy D Girard; Christopher G Hughes; Jennifer L Thompson; Amy L Kiehl; Mark R Elstad; Mitzi L Wasserstein; Richard B Goodman; Jean C Beckham; Rameela Chandrasekhar; Robert S Dittus; E Wesley Ely; Pratik P Pandharipande Journal: Am J Respir Crit Care Med Date: 2016-06-15 Impact factor: 21.405
Authors: Dimitry S Davydow; Jeneen M Gifford; Sanjay V Desai; O Joseph Bienvenu; Dale M Needham Journal: Intensive Care Med Date: 2009-01-23 Impact factor: 17.440
Authors: Hannah Wunsch; Christian F Christiansen; Martin B Johansen; Morten Olsen; Naeem Ali; Derek C Angus; Henrik Toft Sørensen Journal: JAMA Date: 2014-03-19 Impact factor: 56.272