gms | German Medical Science

Background: Acute respiratory distress syndrome (ARDS) is characterised by a life-threatening damage of lung parenchyma. Therefore, ARDS requires intensive care unit (ICU) treatment and mandatory mechanical ventilation. Survivors of ARDS often suffer from long term reduction of health-related quality of life (HRQoL) [1], impaired return to work (RtW) [2] and an increased prevalence of psychiatric sequelae like depression, anxiety and posttraumatic stress disorder (PTSD). Cohort studies reveal symptoms of PTSD in up to 29% [3] and symptoms of depression in 33% of ARDS survivors [4]. Taking a closer look at anxiety disorders, symptoms of generalised anxiety disorder are present in 40% [4].

Research Questions: What is the prevalence of symptoms of PTSD, depression and panic disorder (PD) in a German cohort of ARDS survivors (DACAPO-cohort) and to what degree are HRQoL and RtW impaired?

Methods: The aim of the DACAPO-study is to determine the influence of quality of care on HRQoL and RtW. Within the scope of this study 1225 ARDS-patients were enrolled prospectively in 61 German ICUs. A variety of care-related, disease-related and socio-demographic variables were recorded at ICU-admission or diagnosis of ARDS, respectively. 457 out of 880 ICU survivors completed mailed self-report questionnaires at three months after discharge. Depression and PD were assessed by Patient Health Questionnaire (PHQ-D) which is based on the diagnostic criteria of the DSM-IV. PTSD was determined by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14). For the PHQ-D a cut-off value of 5 indicates at least a latent depression. Patients exceeding the value of 31 in PTSS-14 questionnaire were considered at high risk for PTSD. HRQoL was assessed by the 12-Item Short Form Health Survey (SF-12). Data were analysed descriptively.

Results: Mean age of the 457 ARDS survivors who completed the follow up questionnaires was 53.8 (SD = 15.3) years. About two thirds (68.4%) were male. Before the onset of disease 46.2% of the respondents had been in full- or part-time employment. At three months after ICU discharge 78.8% lived at home again and 12.5% had returned to their previous employment, whereby 24.5% received retirement pension. Regarding HRQoL among ARDS survivors, the mean physical component summary score (M = 36.0; SD = 9.8) was lower than the mean mental health component summary score (M = 46.5; SD = 11.5). The mean depression summary score of the PHQ-D was 2.6 (SD = 3.5). Symptoms indicating at least a latent depression were present in 22% of the former ICU-patients. 42% of the ARDS survivors were at elevated risk of PTSD. According to the PHQ-D 5.3 percent displayed symptoms of a PD.

Discussion: Three months after ICU discharge the distribution of age and sex of the DACAPO-cohort is completely in accordance to other large ARDS-cohorts. Impairments in the physical component of HRQoL were markedly more pronounced compared to impairments in the mental HRQoL component. But taking a closer look at psychiatric disorders that are associated with critical illness and prolonged ICU-stay, especially the high proportion of ARDS-survivors at increased risk for PTSD is remarkably. This and the high prevalence rates of depression and PD are in accordance to other studies addressing the occurrence of psychiatric diseases in survivors of critical illness and ARDS.

Implications: The presence of reduced physical HRQoL in combination with frequent occurrence of incapacity to work and high prevalence of PTSD, depression and PD points out the need for specialised i) diagnostic, ii) curative and iii) rehabilitative health services in survivors of ARDS.