Psychiatric Diagnosis Increased After Critical Illness and Mechanical Ventilation

Dr. Christian Fynbo Christiansen Clinical Associate Professor Department of Clinical Epidemiology Aarhus University Interview Invitation
Dr. Christian Fynbo Christiansen
Clinical Associate Professor
Department of Clinical Epidemiology
Aarhus University Hospital What are the main findings of the study?

Dr. Christiansen:  We included 24,179 critically ill nonsurgical patients receiving mechanical ventilation in intensive care units in Denmark, and matched comparison groups of hospitalized patients and the general population. We assessed psychiatric diagnoses and medication prescriptions before and after critical illness.

We found an increased prevalence of psychiatric diagnoses in the 5 year period before critical illness, compared to both other hospitalized patients and the general population.

Among the 9,921 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low, but higher than that for hospitalized patients (0.5% vs 0.2% over the first 3 months) and the general population group (0.02%). The proportion of patients given new psychoactive medication prescriptions was also increased in the first 3 months (12.7% vs 5.0% percent for the hospital group, and 0.7% for the general population), but these differences in new diagnoses and medications largely resolved by the end of the first year of follow-up. Hypnotics, anxiolytics and antidepressants were the most frequently prescribed drugs. Were any of the findings unexpected?

Dr. Christiansen: Although the relative increase in new psychiatric diagnosis and medication use after critical illness were similar, the absolute risks were very different. We found a surprisingly high risk of new psychoactive medication use but a much smaller proportion with a psychiatric diagnosis (from a subsequent psychiatric admission or outpatient clinic visit). This can, however, largely be explained by the Danish health care system with many patients being treated for depression and anxiety by general practitioners. What should clinicians and patients take away from your report?

Dr. Christiansen: We believe patients, caregivers and physicians should be aware of the increased risk.

Discharge planning for these patients may require more comprehensive discussion of follow-up psychiatric assessment and provision of information to caregivers and other family members regarding potential mental health care needs. What recommendations do you have for future research as a result of this study?

Dr. Christiansen: We identified an increased risk of psychiatric illness, but we need to know more about how to prevent and treat psychiatric illness among survivors of critical illness.

In addition we need to know more on the long-term impact of the new psychiatric illness occurring early after hospital discharge.


Psychiatric Diagnoses and Psychoactive Medication Use Among Nonsurgical Critically Ill Patients Receiving Mechanical Ventilation



Last Updated on November 4, 2015 by Marie Benz MD FAAD