Chest
Volume 135, Issue 3, March 2009, Pages 678-687
Journal home page for Chest

Original Research
Critical Care Medicine
Self-Reported Symptoms of Depression and Memory Dysfunction in Survivors of ARDS

https://doi.org/10.1378/chest.08-0974Get rights and content

Background

Survivors of ARDS have well documented physical limitations, but psychological effects are less clear. We determined the prevalence of self-reported depression and memory dysfunction in ARDS survivors.

Methods

Six to 48 (median 22) months after ICU discharge, we administered instruments assessing depression symptoms (Beck Depression Inventory-II [BDI-II]) and memory dysfunction (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 82 ARDS patients who were enrolled in a prospective cohort study in four university-affiliated ICUs.

Results

Sixty-one (74%), 64 (78%), and 61 (74%) patients fully completed the BDI-II, MAC-S (Ability subscale), and MAC-S (Frequency of Occurrence subscale) instruments. Responders (similar to nonresponders) were young (median 42 years, interquartile range [IQR] 35 to 56), with high admission illness severity and organ dysfunction. The median BDI-II score was 12 (IQR 5 to 25). Twenty-five (41%) patients reported moderate-severe depression symptoms and were less likely to return to work than those with minimal-mild symptoms (8/25 [32%] vs 25/36 [69%]; p = 0.005). Median MAC-S (Ability) and MAC-S (Frequency of Occurrence) scores were 76 (IQR 61 to 93) and 91 (IQR 77 to 102), respectively; 8%, 16%, and 20% scored > 2, > 1.5, and > 1 SD(s), respectively, below age-adjusted population norms for each subscale. BDI-II and MAC-S scores were negatively correlated (Spearman coefficient −0.58 and −0.50 for Ability and Frequency of Occurrence subscales, respectively; p < 0.0001). Univariable analyses showed no demographic or illness-severity predictors of BDI-II (including the Cognitive subscale) or MAC-S (both subscales); results were similar when restricted to patients whose primary language was English.

Conclusions

ARDS survivors report a high prevalence of depression symptoms and a lower prevalence of memory dysfunction 6 to 48 months after ICU discharge. Depression symptoms may hinder the return to work, or patients may report these symptoms because of inability to re-enter the workforce.

Section snippets

Patients

The patients in this study had participated in a previously reported prospective cohort study of ARDS survivors enrolled from ICUs at four University of Toronto teaching hospital, between May 1998 and May 2001.9, 11, 18 Eligible patients were at least 16 years old and had a Pao2/inspired fraction of oxygen ratio of 200 or less while receiving mechanical ventilation with a positive end-expiratory pressure of at least 5 cm H2O, airspace changes in all four quadrants on chest radiography, and an

Study Participants

We enrolled 109 ARDS survivors in the cohort, of whom 13 had died and 14 had withdrawn from the study at the time of questionnaire mailing. We sent questionnaires to all remaining 82 patients in the cohort; they were returned at a median of 22 (IQR 12 to 29; range 6 to 48) months post-ICU discharge (Fig 1). Sixty-eight (83%) patients returned the BDI-II and 71 (87%) patients returned the MAC-S questionnaires. Responders were similar to nonresponders (Table 1); they were young (42 [IQR 35 to 56]

Discussion

In this study, critically ill patients who survived an episode of ARDS completed validated instruments assessing self-reported symptoms of depression and memory dysfunction between 6 and 48 months after ICU discharge. These patients had high initial illness severity and no documented psychiatric comorbidity. Our main findings were a high prevalence (41%) of moderate-severe depression symptoms and a lower prevalence (8 to 20%, depending on the definition used) of self-reported memory deficits.

Acknowledgment

We thank Fatma al-Saidi for major contributions to data collection and early analyses.

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  • Cited by (0)

    This study was supported by Physicians' Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation.

    All authors declare that no financial or other potential conflicts of interest exist. Dr. Adhikari had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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