How Does COVID-19 ICU Admission Impact Patients' Mental Health?

What you need to know

• This study aims to measure anxiety, depression, and post-traumatic stress symptoms in COVID-19 patients after ICU discharge.
• Researchers will follow patients for up to 12 months to track psychological impacts over time.
• The findings could help improve support and follow-up care for COVID-19 ICU survivors.

Understanding the Mental Health Impact of COVID-19 ICU Stays

Being admitted to an intensive care unit (ICU) is a physically and emotionally challenging experience for any patient. For those hospitalized with severe COVID-19, the ICU stay may be especially traumatic due to factors like isolation from family, fear of the unknown virus, and potentially invasive treatments like mechanical ventilation.

A team of UK researchers is conducting an important study to better understand how COVID-19 ICU admissions impact patients’ mental health in the months after discharge. Called the PIM-COVID study (Psychological Impact of COVID-19 on Intensive Care Survivors), this research aims to measure rates of anxiety, depression, and post-traumatic stress symptoms among COVID-19 ICU survivors over time.

Why This Research Matters

Previous studies have shown that ICU stays for other conditions can lead to lasting psychological effects in some patients. Up to 30-40% of general ICU survivors report symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD) in the year after discharge. However, the mental health impact of COVID-19 ICU stays specifically is not yet well understood.

The PIM-COVID study will provide valuable data on:

• How common anxiety, depression, and PTSD symptoms are among COVID-19 ICU survivors
• How these symptoms change over time (3, 6, and 12 months after discharge)
• What factors may increase risk for psychological distress
• How COVID-19 ICU stays compare to ICU stays for other conditions in terms of mental health impacts

This information could help hospitals and healthcare systems improve follow-up care and support for COVID-19 ICU survivors. It may also shed light on whether this patient group needs specialized mental health interventions.

How the Study Works

The PIM-COVID study will recruit adult patients across the UK who were admitted to ICUs for COVID-19 and survived to discharge. Key aspects of the study design include:

• Multicenter approach: Recruiting patients from ICUs across England, Northern Ireland, Scotland, and Wales
• Longitudinal follow-up: Surveying patients at 3, 6, and 12 months after ICU discharge
• Mixed methods: Using both questionnaires and interviews to gather data
• Risk factor analysis: Examining demographic, clinical, and psychosocial factors that may predict worse outcomes

Patients will complete several validated questionnaires at each time point, including:

• Hospital Anxiety and Depression Scale (HADS): Measures anxiety and depression symptoms
• Impact of Event Scale-6 (IES-6): Screens for PTSD symptoms
• EQ-5D-5L: Assesses health-related quality of life
• Cognitive Attentional Syndrome Scale (CAS-1R): Examines thought processes and coping strategies

The researchers will also collect clinical data like length of ICU stay, severity of illness, and treatments received.

Measuring Psychological Distress

It’s important to understand how the main psychological outcomes in this study are defined and measured:

Anxiety and Depression: The HADS questionnaire asks patients to rate symptoms like tension, worry, and loss of interest/pleasure over the past week. Scores of 8 or higher (out of 21) on the anxiety or depression subscales indicate clinically significant symptoms.

Post-Traumatic Stress: The IES-6 asks about PTSD symptoms like intrusive thoughts, avoidance, and hyperarousal related to the ICU experience. A mean score of 1.75 or higher (out of 4) suggests probable PTSD.

Quality of Life: The EQ-5D-5L looks at mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Patients rate their overall health on a 0-100 scale.

By measuring these outcomes at multiple time points, the researchers can track how symptoms change over the course of recovery. This longitudinal data is crucial for understanding the trajectory of psychological distress after COVID-19 ICU stays.

Analyzing Risk Factors

A key goal of the PIM-COVID study is to identify factors that may increase a patient’s risk for developing anxiety, depression, or PTSD symptoms after their ICU stay. The researchers will examine potential risk factors like:

• Demographics: Age, sex, education level, socioeconomic status
• Clinical factors: Length of ICU stay, illness severity, ventilation, delirium
• Pre-existing conditions: Physical and mental health comorbidities
• ICU treatments: Use of benzodiazepines, physical restraints
• Psychosocial factors: Thought processes, coping strategies

Understanding these risk factors could help clinicians identify high-risk patients who may need additional mental health support or monitoring after discharge. It may also point to modifiable factors that could be targeted to reduce psychological distress.

Patient Interviews Provide Deeper Insights

In addition to the questionnaires, the researchers will conduct in-depth interviews with a subset of participants. These interviews will explore patients’ experiences during recovery, perceptions of care received, and views on available support.

The qualitative data from interviews will complement the quantitative survey data, providing richer context and insights into patients’ lived experiences. This mixed-methods approach allows for a more comprehensive understanding of the psychological impact of COVID-19 ICU stays.

Examining Available Follow-Up Services

Another component of the PIM-COVID study involves surveying hospitals across the UK about follow-up services offered to COVID-19 ICU survivors after discharge. This will provide important context about the support available to patients during recovery.

Current guidelines recommend that high-risk ICU survivors be invited to follow-up clinics 2-3 months after discharge. However, even before the pandemic, only about 30% of UK hospitals offered dedicated ICU follow-up clinics. Understanding geographical differences in follow-up care could highlight gaps in support for COVID-19 survivors.

Potential Impact of Findings

The results of the PIM-COVID study have the potential to impact clinical practice and health policy in several ways:

1. Inform follow-up care: Findings on rates and trajectories of psychological distress could guide recommendations for routine mental health screening and support after COVID-19 ICU stays.

2. Identify high-risk patients: Risk factor analysis may help clinicians flag patients who need closer monitoring or early intervention for mental health issues.

3. Tailor interventions: Understanding common thought patterns and coping strategies could inform development of targeted psychological interventions for this population.

4. Improve services: Data on gaps in follow-up care may drive efforts to expand access to post-ICU support services.

5. Guide resource allocation: Prevalence data could help health systems plan for mental health needs of COVID-19 ICU survivors.

Conclusions

• The PIM-COVID study will provide crucial data on the psychological impact of COVID-19 ICU stays over time.
• Findings on rates of anxiety, depression, and PTSD symptoms could inform follow-up care practices.
• Identifying risk factors may help target additional support to high-risk patients.
• Results have potential to improve care and outcomes for COVID-19 ICU survivors.

While focused on COVID-19, this research may also yield broader insights into the psychological effects of critical illness and ICU stays. As the pandemic continues, understanding and addressing the mental health needs of ICU survivors will be an important part of comprehensive COVID-19 care.