Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress
Abstract
Abstract Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care–based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up. Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).
Article Details
Authors (108)
Robert Philipp Kosilek
Nora Schröder
Linda Sanftenberg
Daniela Lindemann
Antina Beutel
Konrad Schmidt
Christian Brettschneider
Hans-Helmut König
Jochen Gensichen
Christine Adrion
Matthias Angstwurm
Antje Bergmann
Gerhard Bielmeier
Andrea Bischhoff
Ralph Bogdanski
Katja Brenk-Franz
Franz Brettner
Josef Briegel
Martin Bürkle
Johanna Dohmann
Thomas Elbert
Peter Falkai
Thomas Felbinger
Richard Fisch
Hans Förstl
Benjamin Fohr
Martin Franz
Patrick Friederich
Chris-Maria Friemel
Jürgen Gallinat
Sabine Gehrke-Beck
Herwig Gerlach
Andreas Güldner
Hanna Hardt
Irene Heimbeck
Christoph Heintze
Andreas Heinz
Axel Heller
Simona Hennig
Christian von Heymann
Petra Hoppmann
Volker Huge
Michael Irlbeck
Ulrich Jaschinski
Dominik Jarczak
Stefanie Joos
Caroline Jung-Sievers
Elisabeth Kaiser
Melanie Kerinn
Frank-Rainer Klefisch
Stefan Kluge
Roland Koch
Thea Koch
Michelle Kowalski
Peter Lackermeier
Karl-Ludwig Laugwitz
Tri Le
Yvonne Lemke
Achim Lies
Klaus Linde
Dagmar Lühmann
Stephanie May
Ludwig Ney
Jan Oltrogge
Wulf Pankow
Sergi Papiol
Maximilian Ragaller
Nikolaus Rank
Jonas Raub
Lorenz Reill
Ulf-Dietrich Reips
Siegfried Reitberger
Hans-Peter Richter
Reimer Riessen
Grit Ringeis
Ann Rüchardt
Maggie Schauer
Gustav Schelling
Jörg Schelling
André Scherag
Martin Scherer
Antonius Schneider
Gerhard Schneider
Jürgen Schneider
Sophie Schneider
Julia Schnurr
Tomke Schubert
Susanne Schultz
Thomas G. Schulze
Karin Schumacher
John Singhammer
Peter Spieth
Kerstin Theisen
Franka Thurm
Natalia Unruh
Thomas Vogl
Institute of Immunology, University of Münster
Karen Voigt
Cornelia Wäscher
Andreas Walther
Life-Like Materials and Systems, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
Dietmar Wassilowsky
Regina Wehrstedt
Roland Weierstall-Pust
Marion Weis
Björn Weiss
Georg Weiss
Harald Well
Christian Zöllner
Bernhard Zwissler