Mental Illness After Intensive Care: A Population Based Cohort Study
CCCF ePoster library. Sivanathan L. Nov 9, 2018; 234191
Lavarnan Sivanathan
Lavarnan Sivanathan
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Abstract
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Introduction: Small studies have reported increased risk for new-onset mental illness in intensive care unit (ICU) survivors.1–3 Only one prior study has examined this on a population-level, but was restricted to psychiatrist diagnoses so may have underestimated diagnosis rates.4 Objectives: We sought to determine the incidence of new-onset mental illness across a large population of ICU survivors, including diagnoses by non-specialist and specialist physicians. Our secondary objective was to identify which common ICU procedures are associated with a higher risk of mental illness.  Methods: This population-based observational study including adult ICU survivors (age ≥ 18 years) in Ontario, Canada (2005 – 2015) excluded patients with previously diagnosed mental illness, acute neurological injury (e.g., traumatic brain injury, stroke, intracranial monitors, cardiac arrest), and conditions already known to increase risk of mental illness (e.g. cardiac surgery, pregnancy). The primary outcome was a new diagnosis of mental illness during 1-year of follow-up after discharge, identified using Ontario health administrative outpatient and inpatient datasets.  For comparison, we measured outcome rates in patients hospitalized during the same period but not requiring ICU admission. Fine and Grey multivariable models were used to evaluate outcome incidence after adjusting for confounders (age, sex, length of stay, rurality and income quintile), while accounting for the competing risk of death. Results: 1,847,631 patients survived their index hospitalization, of whom 121,125 (6.6%) required an ICU admission. Patients who were admitted to ICU had a higher 1-year crude and adjusted incidence of mental illness than hospitalized (non-ICU) controls (crude rates 17% vs 15%, p<0.001; adjusted HR 1.1, 95% CI 1.1 to 1.1, p<0.001). Most mental illness diagnoses (90%) were made by non-psychiatrists. Among ICU patients surviving to hospital discharge, several interventions were associated with increased 1-year crude and adjusted incidence of mental illness: mechanical ventilation (crude rates 19% vs 17%, p<0.001; adjusted HR: 1.2, 95% CI 1.1 to 1.2, p<0.001), tracheostomy (crude rates 22% vs 17%, p<0.001; adjusted HR: 1.3, 95% CI 1.2 to 1.4, p<0.001), percutaneous feeding tube (crude rates 20% vs 17%, p<0.001; adjusted HR: 1.2, 95% CI 1.1 to 1.3, p<0.001), bronchoscopy (crude rates 20% vs 17%, p<0.001; adjusted HR: 1.2, 95% CI 1.1 to 1.3, p<0.001), chest-tube (crude rates 20% vs 17%, p<0.001; adjusted HR: 1.1, 95% CI 1.1 to 1.2, p<0.001) and length of stay 5 or more days (crude rates 19% vs 17%, p<0.001; adjusted HR: 1.1, 95% CI 1.04 to 1.10). Conclusions: Rates of incident mental illness after hospitalization are high, and ICU admission slightly increases the risk. Several common ICU procedures are associated with increased risk of subsequent mental illness; these patients could be considered for more targeted support following discharge from hospital.

 


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