{"id":123,"date":"2014-08-21T18:27:44","date_gmt":"2014-08-21T18:27:44","guid":{"rendered":"http:\/\/wp-dev.its.vanderbilt.edu\/vanderbiltmedicine\/?p=123"},"modified":"2021-08-11T19:42:15","modified_gmt":"2021-08-11T19:42:15","slug":"physical-signs-of-depression-common-among-icu%e2%80%88survivors","status":"publish","type":"post","link":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/physical-signs-of-depression-common-among-icu%e2%80%88survivors\/","title":{"rendered":"Physical signs of depression common among ICU\u2008survivors"},"content":{"rendered":"
\"Illustration<\/a>
Illustration by Jon Krause.<\/figcaption><\/figure>\n

Depression affects more than one out of three survivors of critical illness, according to a Vanderbilt study released in The Lancet Respiratory Medicine, and the majority of patients experience their symptoms physically rather than mentally.<\/p>\n

It is one of the largest studies to investigate the mental health and functional outcomes of critical care survivors, according to lead author James Jackson, Psy.D., assistant professor of Medicine, and it highlights a significant public health issue, with roughly 5 million patients admitted to intensive care units (ICUs) in the United States each year.<\/p>\n

Weakness, appetite change and fatigue\u2014all signs of somatic, or physical, depression\u2014were present in two-thirds of the patients, as\u00a0opposed to cognitive symptoms such as sadness, guilt or pessimism.<\/p>\n

\u201cWe need to pay more attention to preventing and treating the physical rather than psychological symptoms of depression in ICU\u00a0survivors,\u201d Jackson said. \u201cThe physical symptoms of depression are often resistant to standard treatment with antidepressant drugs, so we need to determine how best to enhance recovery with a new focus on physical and occupational rehabilitation.\u201d<\/p>\n

The BRAIN-ICU study observed 821 critically ill patients ages 18-90 with respiratory failure or severe sepsis (blood poisoning) admitted to medical or surgical ICUs at Vanderbilt University Hospital and Saint Thomas Hospital.<\/p>\n

Vanderbilt researchers assessed survivors for depression, PTSD, functional disability and impact on quality of life at three-month and one-year intervals, reporting that 149 of the 407 patients (37 percent)\u00a0assessed at three months had at least mild depression, while only 7\u00a0percent of patients experienced symptoms of PTSD.<\/p>\n

\u201cDepression symptoms were significantly more common than symptoms of PTSD,\u201d Jackson said. \u201cAnd they occurred to a large degree across the entire age range. People tend to have a vision of a frail, older patient who goes to the ICU and is at risk for adverse mental health and, in particular, functional outcomes. But what people don\u2019t anticipate is someone in their 20s, 30s or 40s could go to the ICU and leave with functional disability, depression or PTSD. These problems are not really a function of old age.\u201d<\/p>\n

One-third of the survivors who developed depression still had depressive symptoms at their one-year assessment, a statistic that Jackson said could, in part, be due to high expectations they set for rehabilitation.<\/p>\n

\u201cThey have some arbitrary timeline set and they reach that date and they\u2019re still not better and, in some cases, not a lot better at all,\u201d he said. \u201cThen what can happen is that depression can really worsen because they set this expectation that was really unrealistic and they feel like they have missed the goal.<\/p>\n

\u201cSo that\u2019s a big challenge, recalibrating expectations. This is especially hard for the many high-achieving, type A patients that we might see who leave the ICU and want to get back to work right away, want to compete in the triathlon right away. They tend to have the hardest time,\u201d he said.<\/p>\n

Jackson said study authors gained additional perspective on their patients by doing at-home assessments following discharge.<\/p>\n

\u201cWhat it enabled us to do was to see patients in their real-life surroundings in actual circumstances in which they were sometimes a little more willing, I think, to disclose their problems. When you see someone in a hospital, the situation is a little more sterile. When you get to know them in their homes, we felt like you really get to know them and that was often the context where they told us about their depression.<\/p>\n

\u201cOne thing we learned was that if people don\u2019t have significant social support, they are profoundly limited in their ability to access care or improve in key areas,\u201d he added.<\/p>\n

Vanderbilt is now following ICU patients after discharge through the Vanderbilt ICU Recovery Center, which opened in late 2012, Jackson said.<\/p>\n

The study was led by members of Vanderbilt\u2019s ICU Delirium and Cognitive Impairment Group, which includes senior author Wes Ely, M.D., professor of Medicine, and co-author Pratik Pandharipande, M.D., MSCI, professor of Anesthesiology and Critical Care.<\/p>\n

 <\/p>\n

The research is supported by grants from the National Institutes of Health (AG027472, AG035117, AG034257, AG031322, AG040157, HL111111, and 2 T32 HL087738-06), and the Veterans Affairs Tennessee Valley.<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Depression affects more than one out of three survivors of critical illness, according to a Vanderbilt study released in The Lancet Respiratory Medicine, and the majority of patients experience their symptoms physically rather than mentally. It is one of the largest studies to investigate the mental health and functional outcomes of critical care survivors, according…<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_links_to":"","_links_to_target":""},"categories":[11,22],"tags":[],"class_list":["post-123","post","type-post","status-publish","format-standard","hentry","category-vm-around-the-medical-center","category-vm-summer-2014"],"acf":[],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pcDnub-1Z","_links":{"self":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/comments?post=123"}],"version-history":[{"count":1,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/123\/revisions"}],"predecessor-version":[{"id":3201,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/123\/revisions\/3201"}],"wp:attachment":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/media?parent=123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/categories?post=123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/tags?post=123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}