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Critically ill adults who survive a stint in the intensive care unit (ICU) have a small, increased risk for future suicide and self-harm compared to their peers with a non-ICU hospital stay, new research shows.

In addition, the study revealed that younger patients who have a history of mental illness may be particularly susceptible to suicide attempts following a stint in the ICU.

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After a few days spent on the observation floor, I was set and free to go home, as the symptoms I was having then were not happening. The syncope only occurred when I was standing and at very random times, like when I'd lift my hand(s) too high or got up to fast, or just plain no reason, I'd spill to the floor - HARD.

It wouldn't be long until I got a workup from my new primary doctor, that based on my history and diagnosis of autonomic dysfunction, that the medication I had a reaction to, likely caused an onset of POTS (Post Orthostatic Tachycardia Syndrome)2 - something I'd previously been diagnosed with years and years ago, but never needed to be medicated for.

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As soon as I see the name on my phone, it all comes back to me.

I remember the nights we spent outside his hospital room, adjusting his ventilator settings. I remember the anxious call to his family when he started to bleed into his lungs, and we did not know if he would make it. I can still picture the guide to Islamic end-of-life rituals that his nurses passed from shift to shift, the way it grew dog-eared and tattered.

Somehow, my patient survived Covid-19. He saw his son off to college. He was even able to return to work part-time as the manager of the liquor store near his home. In a way, his life is back to normal. But he is still haunted by the delirious hallucinations that make him feel as if he’s still in the intensive care unit. They’re his only memories of the experience.

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More must be done to support people with long Covid and their loved ones, academics have said.

Here, the PA news agency answers the key questions about the condition.

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New Delhi: More than 100 cases of multi-organ inflammatory syndrome in children (MIS-C) have been reported in northern India in the last five days as post-Covid reaction, Indian Academy of Pediatric Intensive Care said citing its data.

According to the academy, the sudden spurt in MIS-C cases has been observed typically in post-Covid patients mostly between 4 to 18 years. However, there are rare cases of MIS-C affecting babies six months old.

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Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge.

Design Population based cohort study using linked and validated provincial databases.

Setting Ontario, Canada between January 2009 and December 2017 (inclusive).

Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period.

Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models.

Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56).

Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

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TORONTO — Patients discharged from intensive care are at higher risk of suicide, according to new research, suggesting that people who survive a serious COVID-19 infection could also be more likely to harm themselves.

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On 3 September The BMJ hosted an online webinar on the diagnosis, management, and prognosis of “long covid.” An expert panel discussed its symptoms, course, and character and suggested strategies for managing it. Nikki Nabavi reports

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Young, low risk patients with ongoing symptoms ofcovid-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.1Initial data from 201 patients suggest that almost 70%had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection. The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection.

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Most people who get COVID-19 recover within a few weeks.
But months later, some continue to struggle with symptoms.
They’ve become known as the “long haulers.” The phenomenon is also called “long COVID-19” or “post-COVID-19 syndrome.”
“As things progress, hopefully the terminology will settle on one or another,” said Dr. Matthew J. Ashley, a neurologist at the Centre for Neuro Skills in California.
Whatever you call it, the long-term effects of COVID-19 are estimated to affect 25 to 30 percent of people who’ve had the disease.
“It’s hard to define what really belongs in this category,” Ashley told Healthline.
“There are a lot of emerging and serious long-term consequences of COVID-19 that relate back to the illness but are separate and distinct things,” he said, “such as stroke, heart attack, anoxic brain injury, Guillain-Barré syndrome, pulmonary embolism, DVT, etc., that occur in some patients because of COVID-19 and its consequences.”
“Then there are the unfortunate people who end up spending weeks in the hospital and ICU who experience associated complications from that, including post-ICU syndrome, PTSD, or the like,” Ashley added. “Whether this is part of the ‘long-hauler’ syndrome or not, it certainly causes significant long-term consequences for people and deserves attention.”

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When we talk about coronavirus, we tend to talk in numbers—the number of cases (nearly 18 million so far), the number of deaths (more than 318,000 this year), the number of hospitalizations (ICUs in some cities have zero beds left). Left uncounted are those who got COVID—and are still alive but suffering brutally. These so-called "long-haulers" can't shake Post-COVID Syndrome, and have had their lives ruined, possibly forever. It's an "unexplainable symptom complex that seems to be consistent among them without any laboratory data to indicate why they may be feeling that way," Dr. Anthony Fauci, the nation's leading infectious disease expert, told Mark Zuckerberg last month. Dr. Fauci listed the symptoms associated with this "long COVID"—read on to see if you have them, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.

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Suppose you are suddenly are stricken with COVID-19. You become very ill for several weeks. On awakening every morning, you wonder if this day might be your last.
And then you begin to turn the corner. Every day your worst symptoms — the fever, the terrible cough, the breathlessness — get a little better. You are winning, beating a life-threatening disease, and you no longer wonder if each day might be your last. In another week or two, you’ll be your old self.
But weeks pass, and while the worst symptoms are gone, you’re not your old self — not even close. You can’t meet your responsibilities at home or at work: no energy. Even routine physical exertion, like vacuuming, leaves you feeling exhausted. You ache all over. You’re having trouble concentrating on anything, even watching TV; you’re unusually forgetful; you stumble over simple calculations. Your brain feels like it’s in a fog.
Your doctor congratulates you: the virus can no longer be detected in your body. That means you should be feeling fine. But you’re not feeling fine.
The doctor suggests that maybe the terrible experience of being ill with COVID-19 has left you a little depressed, or experiencing a little PTSD. Maybe some psychiatric treatment would help, since there’s nothing wrong with you physically. You try the treatment, and it doesn’t help.