Critical illness increases risk of psychological problems

New research shows that every seventh person who has received mechanical ventilation risks developing anxiety, depression and insomnia. Improved prevention is needed, according to the professor behind the study.

Fortunately, more and more people survive critical illnesses and accidents. A new Danish-American survey shows, however, that hospitalisation where the patient has received mechanical ventilation can have serious consequences:

- Of course, the good news is that more and more patients survive critical illness and treatment using ventilators. But at the same time, the bad news is that we have now documented that the ventilator patients have a considerable risk of developing psychological problems.

The first few months after discharge are really critical, says professor of clinical epidemiology Henrik Toft Sørensen, Aarhus University and Aarhus University Hospital.

He is behind the hitherto largest study of psychiatric problems before and after treatment that involves mechanical ventilation treatment. The sensational results have just been published in the prestigious Journal of the American Medical Association (JAMA).

In the study, 24,179 mechanically ventilated patients admitted to all Danish intensive care units in the period 2006-2008 were compared with other admitted patients, as well as with the general population.

Surprisingly many

"The study shows that up to 13 percent of the ventilator patients - that's to say one in seven - were prescribed medication for psychological problems within the first three months after the hospital admission. We were well aware that there was an increased risk, but we had not expected the figure to be so high," says Henrik Toft Sørensen, and adds:

"By comparison, five percent of the patients who had not been mechanically ventilated received medication for psychological problems after the hospital admission."

The medication typically covers sleeping medicine, anxiety medication or antidepressant medicine.

Half a percent of the mechanically ventilated patients had such severe psychological problems that they received a psychiatric diagnosis from a psychiatric hospital within the first 3 months after the hospital discharge.

Serious consequences

Henrik Toft Sørensen believes that there is a considerable need for an increased focus on prevention and treatment of psychological problems in patients who survive critical illness:

"Psychological problems have profound human and socio-economic costs. Among patients, relatives and medical doctors, there ought to be a much greater degree of knowledge and awareness of the long-term consequences of critical illness. It is important that we all become better at taking early steps towards the right prevention and treatment," he says.