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Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

Female gender, early levels of increased stress and problems sleeping are associated with worse psychological recovery for survivors of critical illness.

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References

  1. Moreno RP, Rhodes A, Donchin Y (2009) Patient safety in intensive care medicine: the Declaration of Vienna. Intensive Care Med 35:1667–1682

    Article  PubMed  Google Scholar 

  2. Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA (2006) Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med 34:1016–1024

    Article  PubMed  Google Scholar 

  3. Drennan K, Hart G, Hicks P (2008) Intensive care resources & activity: Australia & New Zealand 2006/2007. ANZICS, Melbourne

    Google Scholar 

  4. Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377

    PubMed  Google Scholar 

  5. Kahn JM, Angus DC (2007) Health policy and future planning for survivors of critical illness. Curr Opin Crit Care 13:514–518

    Article  PubMed  Google Scholar 

  6. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 31:611–620

    Article  PubMed  Google Scholar 

  7. Davydow DS, Desai SV, Needham DM, Bienvenu OJ (2008) Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosom Med 70:512–519

    Article  PubMed  Google Scholar 

  8. Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM (2009) Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 35:796–809

    Article  PubMed  Google Scholar 

  9. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ (2008) Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 30:421–434

    Article  PubMed  Google Scholar 

  10. Griffiths J, Fortune G, Barber V, Young J (2007) The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 33:1506–1518

    Article  PubMed  Google Scholar 

  11. Rubenfeld GD (2007) Interventions to improve long-term outcomes after critical illness. Curr Opin Crit Care 13:476–481

    Article  PubMed  Google Scholar 

  12. Elliott D, McKinley S, Alison JA, Aitken LM, King MT (2006) Study protocol: home-based physical rehabilitation for survivors of a critical illness [ACTRN12605000166673]. Crit Care 10:R90S

    Article  Google Scholar 

  13. Ware JE, Snow KK, Kosinski M (2000) SF-36 version 2 health survey: manual and interpretation guide. Lincoln, Quality Metric Incorporated

    Google Scholar 

  14. Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33:335–343

    Article  PubMed  CAS  Google Scholar 

  15. Horowitz M, Wilner N, Alvarez W (1979) Impact of events scale: a measure of subjective stress. Psychosomatic Med 41:209–218

    CAS  Google Scholar 

  16. Joseph S (2000) Psychometric evaluation of Horowitz’s Impact of Event Scale: a review. J Trauma Stress 13:101–113

    Article  PubMed  CAS  Google Scholar 

  17. Sintonen H (2001) The 15D instrument of health-related quality of life: properties and applications. Ann Med 33:328–336

    Article  PubMed  CAS  Google Scholar 

  18. Elliott D, McKinley S, Alison J, Aitken LM, King M, Leslie GD, Kenny P, Taylor FoleyR, Burmeister E (2011) Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 15:R142

    Article  PubMed  Google Scholar 

  19. Lovibond SH, Lovibond PF (2004) Manual for the depression anxiety stress scales, Psychology Foundation Monograph. University of New South Wales, Kensington

    Google Scholar 

  20. Ware JE, Kosinski M (2001) Interpreting SF-36 summary health measures: a response. Qual Life Res 10:405–413

    Article  PubMed  CAS  Google Scholar 

  21. Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, Pronovost PJ, Needham DM (2006) Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med 32:1115–1124

    Article  PubMed  Google Scholar 

  22. Sukantarat K, Greer S, Brett S, Williamson R (2007) Physical and psychological sequelae of critical illness. Br J Health Psychol 12:65–74

    Article  PubMed  Google Scholar 

  23. Hofhuis JG, Spronk PE, van Stel HF, Schrijvers GJ, Rommes JH, Bakker J (2008) The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest 133:377–385

    Article  PubMed  Google Scholar 

  24. Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, Hull A, Breeman S, Norrie J, Jenkinson D, Hernandez R, Johnston M, Wilson E, Waldmann C (2009) The practical study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ 339:b3723. doi:10.1163/bmj.b3723

    Article  PubMed  CAS  Google Scholar 

  25. Rattray JE, Hull AM (2008) Emotional outcome after intensive care: literature review. J Adv Nurs 64:2–13

    Article  PubMed  Google Scholar 

  26. Rattray JE, Johnston M, Wildsmith JA (2005) Predictors of emotional outcomes of intensive care. Anaesthesia 60:1085–1092

    Article  PubMed  CAS  Google Scholar 

  27. Sukantarat KT, Williamson RC, Brett SJ (2007) Psychological assessment of ICU survivors: a comparison between the hospital anxiety and depression scale and the depression, anxiety and stress scale. Anaesthesia 62:239–243

    Article  PubMed  CAS  Google Scholar 

  28. Sundin EC, Horowitz MJ (2003) Horowitz’s impact of event scale evaluation of 20 years of use. Psychosom Med 65:870–876

    Article  PubMed  Google Scholar 

  29. Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Ely EW (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11:R27

    Article  PubMed  Google Scholar 

  30. Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68:748–766

    Article  PubMed  CAS  Google Scholar 

  31. Griffiths JA, Barber VS, Cuthbertson BH, Young JD (2006) A national survey of intensive care follow-up clinics. Anaesthesia 61:950–955

    Article  PubMed  CAS  Google Scholar 

  32. Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A (1999) Quality of life after prolonged intensive care. Crit Care Med 27:1132–1139

    Article  PubMed  CAS  Google Scholar 

  33. Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J (2003) Morbidity, mortality, and quality-of-life outcomes of patients requiring ≥14 days of mechanical ventilation. Crit Care Med 31:1373–1381

    Article  PubMed  Google Scholar 

  34. Orwelius L, Nordlund A, Nordlund P, Edell-Gustafsson U, Sjoberg F (2008) Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study. Crit Care 12:R97

    Article  PubMed  Google Scholar 

  35. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A (2005) Patients’ recollections of experiences in the intensive care unit may affect their quality of life. Crit Care 9:R96–R109

    Article  PubMed  Google Scholar 

  36. Lee CM, Herridge MS, Gabor JY, Tansey CM, Matte A, Hanly PJ (2009) Chronic sleep disorders in survivors of the acute respiratory distress syndrome. Intensive Care Med 35:314–320

    Article  PubMed  Google Scholar 

  37. Bonnet MH, Arand DL (2009) Hyperarousal and insomnia: State of the science. Sleep Med Rev

  38. Aurell J, Elmqvist D (1985) Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care. Br Med J (Clin Res Ed) 290:1029–1032

    Article  CAS  Google Scholar 

  39. Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ (2001) Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 163:451–457

    PubMed  CAS  Google Scholar 

  40. Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ (2003) Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 167:708–715

    Article  PubMed  Google Scholar 

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Acknowledgments

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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Authors and Affiliations

  1. Faculty of Nursing Midwifery and Health, University of Technology Sydney, Northern Sydney Local Health District, Sydney, NSW, Australia

    Sharon McKinley

  2. Research Centre for Clinical and Community Practice Innovation, Intensive Care Unit, Griffith University, Princess Alexandra Hospital, Queensland, Australia

    Leanne M. Aitken & Elizabeth Burmeister

  3. Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia

    Jennifer A. Alison

  4. Cancer Australia Chair in Cancer Quality of Life, School of Psychology, The University of Sydney, Sydney, NSW, Australia

    Madeleine King

  5. Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University of Technology, Perth, WA, Australia

    Gavin Leslie

  6. Faculty of Nursing Midwifery and Health, University of Technology Sydney, Sydney, NSW, Australia

    Doug Elliott

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  1. Sharon McKinley
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  2. Leanne M. Aitken
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  3. Jennifer A. Alison
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  4. Madeleine King
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  5. Gavin Leslie
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  6. Elizabeth Burmeister
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  7. Doug Elliott
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Corresponding author

Correspondence to Sharon McKinley.

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McKinley, S., Aitken, L.M., Alison, J.A. et al. Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness. Intensive Care Med 38, 627–633 (2012). https://doi.org/10.1007/s00134-012-2477-4

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  • DOI: https://doi.org/10.1007/s00134-012-2477-4

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