Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Sina Nikayin; Anahita Rabiee; Mohamed D Hashem; Minxuan Huang; O Joseph Bienvenu; Alison E Turnbull; Dale M Needham

doi:10.1016/j.genhosppsych.2016.08.005

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Gen Hosp Psychiatry. 2016 Nov-Dec:43:23-29. doi: 10.1016/j.genhosppsych.2016.08.005. Epub 2016 Aug 28.

Authors

Sina Nikayin¹, Anahita Rabiee¹, Mohamed D Hashem¹, Minxuan Huang¹, O Joseph Bienvenu², Alison E Turnbull³, Dale M Needham⁴

Affiliations

¹ Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
² Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD.
³ Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
⁴ Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD. Electronic address: dale.needham@jhmi.edu.

Abstract

Objectives: To evaluate the epidemiology of and postintensive care unit (ICU) interventions for anxiety symptoms after critical illness.

Methods: We searched five databases (1970-2015) to identify studies assessing anxiety symptoms in adult ICU survivors. Data from studies using the most common assessment instrument were meta-analyzed.

Results: We identified 27 studies (2880 patients) among 27,334 citations. The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale was the most common instrument (81% of studies). We pooled data at 2-3, 6 and 12-14month time-points, with anxiety symptom prevalences [HADS-A≥8, 95% confidence interval (CI)] of 32%(27-38%), 40%(33-46%) and 34%(25-42%), respectively. In a subset of studies with repeated assessments in the exact same patients, there was no significant change in anxiety score or prevalence over time. Age, gender, severity of illness, diagnosis and length of stay were not associated with anxiety symptoms. Psychiatric symptoms during admission and memories of in-ICU delusional experiences were potential risk factors. Physical rehabilitation and ICU diaries had potential benefit.

Conclusions: One third of ICU survivors experience anxiety symptoms that are persistent during their first year of recovery. Psychiatric symptoms during admission and memories of in-ICU delusional experiences were associated with post-ICU anxiety. Physical rehabilitation and ICU diaries merit further investigation as possible interventions.

Keywords: Anxiety; Critical care; Critical illness; Meta-analysis; Review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Anxiety / epidemiology
Anxiety / psychology*
Critical Illness / epidemiology
Critical Illness / psychology*
Critical Illness / therapy
Humans
Intensive Care Units* / statistics & numerical data
Survivors / psychology*
Survivors / statistics & numerical data

Grants and funding

R24 HL111895/HL/NHLBI NIH HHS/United States