Developing an early screening instrument for predicting psychological morbidity after critical illness

Area of Science:

• Critical care medicine
• Psychological outcomes
• Health services research

Background:

• Intensive care unit (ICU) survivors require follow-up care.
• Identifying psychological distress post-ICU is crucial for treatment and resource allocation.
• A predictive screening instrument at ICU discharge can identify at-risk patients.

Purpose of the Study:

• To develop a predictive screening instrument for identifying ICU patients at risk of post-traumatic stress, anxiety, or depression.
• To aid clinicians in early identification of psychological problems in ICU survivors.

Main Methods:

• Prospective collection of 21 potential risk factors at ICU discharge.
• Administration of Post-Traumatic Stress Symptom scale-10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) two months post-discharge to 252 survivors.
• Analysis of patient characteristics and ICU-related variables to identify predictors.

Main Results:

• 31% of 150 responders experienced adverse psychological outcomes (PTSS-10 >35 or HADS ≥8).
• Six predictors identified: pre-existing disease, parental status, previous psychological issues, in-ICU agitation, unemployment/sick-leave, and depressive appearance.
• Screening instrument achieved a predictive accuracy of 0.77 (AUC), with risk groups showing 12% (low), 50% (moderate), and 63% (high) adverse outcome prevalence.

Conclusions:

• A screening instrument developed can assist ICU clinicians in identifying patients at risk for adverse psychological outcomes.
• The tool predicts psychological risk two months after critical illness.
• External validation is required before widespread clinical implementation.