How Often Do Patients Use Mental Health Services After Intensive Care?

What you need to know

• About 27-29% of patients used mental healthcare services after a prolonged intensive care unit (ICU) stay
• Women, pensioners, those with previous therapy experience, and patients with more sepsis episodes were more likely to seek mental healthcare
• Men and those with pre-existing mental health diagnoses were less likely to seek help
• Around 1 in 10 patients with post-traumatic stress disorder (PTSD) or depression did not receive mental healthcare

Background

Surviving a prolonged stay in an intensive care unit can take a major toll on a person’s mental health. Patients may experience anxiety, depression, post-traumatic stress disorder (PTSD), and other psychological issues after discharge. However, we don’t know much about how often these patients actually seek mental health treatment afterwards.

This study aimed to examine:

1. How many patients use mental health services after a long ICU stay
2. What factors are associated with seeking mental healthcare
3. Why some patients who may need help don’t get it

Understanding these patterns could help improve follow-up care for ICU survivors.

Study details

The researchers looked at 197 patients who had been treated in intensive care for at least 6 days. They interviewed patients at three time points:

• Within 4 weeks of ICU discharge
• 3 months after discharge
• 6 months after discharge

At each time point, they assessed patients for symptoms of depression and PTSD. They also asked about use of mental health services like psychotherapy.

Key findings

Mental health service use

• At 3 months post-ICU:

  • 26.8% of patients had used mental health services
  • 18.8% were interested in receiving contact info for therapists

• At 6 months post-ICU:

  • 29.3% had used mental health services
  • 17.3% were interested in therapist contact info

Factors associated with seeking help

Patients were more likely to use mental health services if they:

• Were female
• Had previous experience with psychotherapy
• Were receiving a pension
• Had more sepsis episodes during their ICU stay

Patients were less likely to seek help if they:

• Were male
• Had a pre-existing mental health diagnosis

Reasons for not seeking help

The most common reasons patients gave for not using mental health services were:

• They didn’t think they needed it
• Physical health issues were a higher priority
• They hadn’t thought about seeking mental healthcare

Unmet need

About 1 in 10 patients who met criteria for PTSD or depression had not received any mental healthcare. This suggests there may be a gap between those who need help and those who receive it.

Implications

These findings highlight some important issues in mental healthcare for ICU survivors:

Gender differences

Men were less likely to seek mental health treatment after intensive care. This fits with broader trends of men being less likely to use mental health services. Targeted outreach and education for male ICU patients may help address this disparity.

Pre-existing conditions

Interestingly, having a prior mental health diagnosis actually decreased the likelihood of seeking help after ICU. The researchers suggest this may be due to factors like:

• Stigma around mental illness
• Lack of insight into need for treatment
• Use of unhealthy coping mechanisms like substance use

Patients with pre-existing mental health issues may need extra support and encouragement to seek help after intensive care.

Unmet need

The fact that around 10% of patients with PTSD or depression symptoms did not receive care points to a gap in follow-up mental health treatment. Better screening and referral processes may help identify and support these patients.

Education and awareness

Many patients reported not thinking about seeking mental healthcare or not believing they needed it. This suggests a need for more education about potential mental health impacts of intensive care and available treatment options.

Conclusions

• About 1 in 4 patients use mental health services after prolonged intensive care
• Certain factors like gender and prior treatment history influence likelihood of seeking help
• There is still unmet need, with some patients not receiving care despite having symptoms
• More efforts are needed to educate patients about mental health after ICU and reduce barriers to seeking treatment

Recommendations

The researchers suggest several ways to improve mental healthcare for ICU survivors:

• Screen all patients for depression and PTSD symptoms at ICU discharge and follow-up appointments
• Provide education about potential psychological effects of intensive care
• Target outreach to groups less likely to seek help, like men
• Improve referral processes to mental health providers
• Develop specialized rehabilitation programs addressing mental health needs
• Train ICU staff on identifying psychological issues
• Address stigma around mental illness and treatment

With growing numbers of ICU survivors, including from COVID-19, addressing the mental health impacts of intensive care is increasingly important. Implementing some of these recommendations could help ensure more patients receive the psychological support they need after critical illness.