Physical and psychological sequelae of critical illness

To measure levels of anxiety, depression and post-traumatic stress among survivors of a critical illness and to relate these symptoms to general health parameters.

A prospective study of patients who had spent a minimum 3 days (median 9 days) in a general intensive care unit (ICU). Of these patients, 51 were interviewed 3 months after discharge and 45 of them were reviewed at 9 months.

General health was assessed by a physical symptom score, the EuroQol 'thermometer' and the Short Form 36 (SF-36) questionnaire. Physical and mental component summary measures (PCS, MCS) were calculated from the SF-36 data. Psychological health was assessed using both the Hospital Anxiety and Depression Scale and the Impact of Events Scale.

At both 3 and 9 months after ICU discharge 24% of patients qualified as a 'case' of anxiety, while similar figures were seen for intrusion (24 and 20%). The incidence of depression (35 and 47%) and avoidance (36 and 38%) was higher on each occasion. Four of the eight SF-36 domains improved with time, as did PCS (from 29.0 to 35.4), but there was no significant difference in physical symptom score, EuroQol value or MCS. Strong correlations were seen between the physical and psychological parameters at each time point.

A substantial proportion of patients who survive a critical illness show evidence of anxiety and depression up to 9 months later, and most of them also have symptoms indicative of post-traumatic stress. Delayed physical recovery may contribute to this psychological morbidity. ICU follow-up clinics should be able to detect patients suitable for psychological intervention.