Objective: To synthesize data on prevalence, natural history, risk factors and post-intensive care unit (ICU) interventions for depressive symptoms in ICU survivors
Data Sources: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (1970 – 2015)
Study Selection: Studies measuring depression after hospital discharge using a validated instrument in >20 adults from non-specialty ICUs
Data Extraction: Duplicate independent review and data abstraction
Data Synthesis: The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n=4,113). The Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), was used most commonly (58%). The pooled HADS-D prevalence (95% confidence interval (CI)) of depressive symptoms at a threshold score ≥8 was 29% (22–36%) at 2–3 months (12 studies, n=1,078), 34% (24–43%) at 6 months, (7 studies, n=760), and 29% (23–34%) at 12–14 months, (6 studies, n=1,041). The prevalence of supra-threshold depressive symptoms (compatible with HADS-D≥8) across all studies, using all instruments, was between 29–30% at all 3 time points. The pooled change in prevalence (95% CI) from 2–3 to 6 months (4 studies, n=387) was 5% (−1% to +12%), and from 6 to 12 months (3 studies, n=412) was 1% (−6% to +7%). Risk factors included pre-ICU psychological morbidity and presence of in-ICU psychological distresssymptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms.
Conclusions: Clinically important depressive symptoms occurred in approximately one-third of ICU survivors, and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.
Keywords Depression; critical illness; critical care; meta-analysis; review