Sense of Coherence in Patients After Intensive Care Treatment: A 1-Year Follow-Up Cohort Study

Patients endure physical, mental and cognitive symptoms after critical illness, and coping is vital to their healing process. Little research exists on associations between sense of coherence (SOC) and patients' health improvements after intensive care unit (ICU) discharge.

To describe the trajectory of SOC and how demographic, clinical and psychosocial variables affect SOC in discharged ICU patients during 12 months of follow-up.

A prospective cohort substudy of a neutral randomized controlled trial in Norway involving discharged ICU patients receiving nurse-led follow-up consultations or standard care. Data were collected in the ward (baseline) and after 3, 6 and 12 months. Univariate and multivariate linear mixed models for repeated measures were fitted with SOC-13 score as the dependent variable.

We included 523 patients with a median of three ICU days, median age 57 years, 47% females, 54% receiving mechanical ventilation and stable SOC during follow-up. Higher SOC was associated with increased age (B = 0.12, 95% CI [0.05, 0.18]), no prior mental health problems (B = 6.69, 95% CI [4.19, 9.19]), no prior use of psychotropics (B = 2.37, 95% CI [0.16, 4.58]) and lower post-traumatic stress symptoms (PTSS) at baseline (B = 5.56, 95% CI [3.50, 7.61]). Low educational level (B = -2.25, 95% CI [-4.10, -0.40]), higher pain interference at baseline (B = -0.46, 95% CI [-0.84, -0.08]) and less social support 3 months later (B = -5.93, 95% CI [-7.87, -3.99]) were associated with lower SOC.

During 12 months after ICU discharge, SOC remained stable. Higher age, no previous mental health problems or use of psychotropics, and lower PTSS were associated with higher SOC. Low education, more pain and low social support were associated with lower SOC.

More vulnerable patients deserve greater attention during general rehabilitation after ICU treatment due to low SOC.