Chest
Volume 140, Issue 6, December 2011, Pages 1484-1493
Journal home page for Chest

Original Research
Critical Care
Self-reported Depressive Symptoms and Memory Complaints in Survivors Five Years After ARDS

https://doi.org/10.1378/chest.11-1667Get rights and content

Background

Survivors of ARDS report depressive symptoms and memory complaints, the prevalence of which after 5 years is unknown.

Methods

We administered instruments assessing symptoms of depression (Beck Depression Inventory II [BDI-II]) and memory complaints (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 64 survivors of ARDS from four university-affiliated ICUs 5 years after ICU discharge. We compared BDI-II scores to quality of life (Medical Outcomes Study 36-Item Short Form [SF-36]) mental health domains (role emotional, mental health, mental component summary), compared BDI-II and MAC-S scores to earlier scores (median, 22 months postdischarge), and examined return to work.

Results

Forty-three (67.2%), 46 (71.9%), and 38 (59.4%) patients fully completed the BDI-II, MAC-S ability subscale, and MAC-S frequency of occurrence subscale, respectively. Responders were young (median, 48 years; first-third quartile [Q1-Q3], 39-61 years) with high illness severity. The median BDI-II score was 10 (Q1-Q3, 3-18); eight of 43 (18.6%) had moderate to severe depressive symptoms compared with 14 of 43 (32.6%) earlier (P = .15, n = 38 with paired data). Median MAC-S ability and MAC-S frequency scores were 81 (Q1-Q3, 57-92) and 91.5 (Q1-Q3, 76-105), respectively, similar to earlier scores (P = .67 and P = .64, respectively); 0% to 4.3% scored > 2 SDs below population norms. Higher BDI-II score was predicted by higher earlier BDI-II score, slower recovery of organ function, and longer duration of mechanical ventilation and ICU stay. Higher MAC-S score was predicted by higher earlier MAC-S score. SF-36 mental health domain scores were very stable (P = .57-.83). BDI-II and SF-36 mental health domains were negatively correlated (Spearman coefficient, −0.50 to −0.82). Most patients returned to work regardless of depressive symptoms (minimal to mild, 31 of 35 [88.6%]; moderate to severe, five of eight [62.5%]; P = .12).

Conclusions

Compared with ∼ 2 years postdischarge from the ICU, depressive symptoms and memory complaints were similar at 5 years. Mental health domains of the SF-36 may not be sensitive to small changes in mood symptoms.

Section snippets

Patients

The patients in this study participated in a prospective cohort study of survivors of ARDS enrolled at four University of Toronto-affiliated ICUs between May 1998 and May 2001.4, 8, 9 Eligible patients were aged ≥ 16 years, had a Pao2/Fio2 ratio of ≤ 200 while receiving mechanical ventilation, with a positive end-expiratory pressure of ≥ 5 cm H2O; airspace changes in all four quadrants on chest radiography; and an identifiable risk factor for ARDS. Patients were excluded if they were immobile

Study Participants

We enrolled 109 survivors of ARDS in the cohort, of whom 21 died and 24 were lost to follow-up by the time of the 5-year evaluation9 (Fig 1). Of 74 known survivors at 5 years, 64 patients were evaluated, of whom 46 (71.9%) returned the BDI-II, 47 (73.4%) returned the MAC-S, and 48 (75.0%) returned either one. A median of 41 months (Q1-Q3, 32.5-52 months) separated the two questionnaire administrations.10 Responders were similar to nonresponders (Table 1); they were relatively young (median age,

Discussion

This study included 48 relatively young patients with high illness severity and no documented psychiatric illness who survived ARDS and answered questionnaires assessing depressive symptoms and memory complaints 5 years after ICU discharge. We found that depressive symptoms at 5 years were similar compared with ∼ 2 years after ICU discharge. The SF-36 mental health domains (MH, RE, and MCS), although correlated with BDI-II at 5 years, were completely stable between assessments and may lack

Acknowledgments

Author contributions: Dr Adhikari had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Adhikari: contributed the design of the analyses, interpretation of the data, and drafting and revision of the manuscript.

Dr Tansey: contributed to the data collection and revision of the manuscript.

Dr McAndrews: contributed to the study design and revision of the manuscript.

Ms Matté: contributed to the data collection,

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    Funding/Support: This work was performed at the University of Toronto and was supported by Physicians' Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation. Dr Cheung is supported by a Canadian Institutes of Health Research Senior Investigator Award and the Lillian Love Chair in Women's Health at the University of Toronto and University Health Network.

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