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Psychiatric Morbidity in Survivors of the Acute Respiratory Distress Syndrome: A Systematic Review

From the Department of Psychiatry and Behavioral Sciences (D.S.D., O.J.B.) and the Division of Pulmonary and Critical Care Medicine (S.V.D., D.M.N.), Johns Hopkins University School of Medicine, Baltimore, Maryland.

Address correspondence and reprint requests to Dimitry Davydow, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 356896, Seattle, WA 98104. E-mail: ddavydo1{at}u.washington.edu

Objective: Acute lung injury (ALI), including its more severe subcategory, acute respiratory distress syndrome (ARDS), is a critical illness associated with considerable morbidity and mortality. Our objective was to summarize data on the prevalence of depressive, posttraumatic stress disorder (PTSD), and other anxiety syndromes amongst survivors of ALI/ARDS, potential risk factors for these syndromes, and their relationships to quality of life.

Methods: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, and PsycINFO. Eligible studies reported data on psychiatric morbidity at least once after intensive care treatment of ALI/ARDS.

Results: Ten observational studies met inclusion criteria (total n = 331). Using questionnaires, the point prevalence of "clinically significant" symptoms of depression ranged from 17% to 43% (4 studies); PTSD, 21% to 35% (4 studies); and nonspecific anxiety, 23% to 48% (3 studies). Studies varied in terms of instruments used, thresholds for clinical significance, baseline psychiatric history exclusions, and timing of assessments (range = 1 month to 8 years). Psychiatrist-diagnosed PTSD prevalence at hospital discharge, 5 years, and 8 years were 44%, 25%, and 24%, respectively. Three studies prospectively assessed risk factors for post-ALI/ARDS PTSD and depressive symptoms; significant predictors included longer durations of mechanical ventilation, intensive care unit stay, and sedation. All four studies that examined relationships between psychiatric symptoms and quality of life found significant negative associations.

Conclusions: The prevalence of psychiatric morbidity in patients surviving ARDS seems high. Future research should incorporate more in-depth diagnostic and risk factor assessments for prevention and monitoring purposes.

Key Words: acute respiratory distress syndrome • depression • posttraumatic stress disorder • anxiety • critical care • outcome assessment (health care)

Abbreviations: ALI = acute lung injury; ARDS = acute respiratory distress syndrome; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CES-D = Center for Epidemiologic Studies Depression scale; GABA = -aminobutyric acid; ICU = intensive care unit; IES = Impact of Events Scale; LOS = length of stay; MADRS = Montgomery-Asberg Depression Rating Scale; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; PTSS-10 = Posttraumatic Symptom Scale-10; QOL = quality of life; SCID = Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition); SCL90r = Symptom Checklist 90r; SF-36 = Medical Outcomes Study Short Form-36; SIP = Sickness Impact Profile; STAS-S = Spielberger State-Trait Anxiety Scale-State.

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