Somatic Depression Common Among Critical Illness Survivors

One out of 3 survivors of critical illness is affected by depression, according to research published in The Lancet Respiratory Medicine.

James Jackson, PsyD, and researchers from Vanderbilt University examined 821 critically ill patients aged 18 to 90 years in the BRAIN-ICU study. Patients were admitted to medical or surgical intensive care units at Vanderbilt University Hospital and Saint Thomas Hospital for respiratory failure or severe sepsis. The patients were assessed for depression, post-traumatic stress disorder (PTSD), functional disability, and impact on quality of life at 3-month and one-year intervals.

The researchers determined 149 of 407 (37%) patients assessed at 3 months had at least mild depression, and only 7% of those patients experienced symptoms of PTSD. The majority of patients experienced their symptoms physically, rather than mentally, including weakness, appetite change, and fatigue. Two-thirds of the patients experienced this somatic depression, as opposed to cognitive symptoms such as sadness, guilt, or pessimism.

“Depression symptoms were significantly more common than symptoms of PTSD,” Jackson said in a press release. “And they occurred to a large degree across the entire age range. People tend to have a vision of a frail, older patient who goes to the ICU and is at risk for adverse mental health and, in particular, functional outcomes. But what people don’t anticipate is someone in their 20s, 30s or 40s could go to the ICU and leave with functional disability, depression or PTSD. These problems are not really a function of old age.”

By 12 months, one-third of survivors who had developed depression still retained depressive symptoms. Jackson attributed this to high expectations participants may have set for their own rehabilitation.

“They have some arbitrary timeline set and they reach that date and they’re still not better and, in some cases, not a lot better at all,” he said. “Then what can happen is that depression can really worsen because they set this expectation that was really unrealistic and they feel like they have missed the goal. So that’s a big challenge, recalibrating expectations. This is especially hard for the many high-achieving, type A patients that we might see who leave the ICU and want to get back to work right away, want to compete in the triathlon right away. They tend to have the hardest time.”

Jackson also said the at-home assessments were particularly insightful for the study. At-home visits enabled the researchers to gather information about participants’ real-life surroundings in locations where Jackson believes they were more likely to disclose their problems.

“One thing we learned was that if people don’t have significant social support, they are profoundly limited in their ability to access care or improve in key areas,” Jackson said.