February 21, 2022

Article Review - Journal Rewiew Club

A Canadian population-based study

 

The relationship between critical illness and mental disorders is poorly understood.

This study aimed to measure the treated prevalence of mental disorders and psychotropic medication use before and after hospitalisation, mainly focusing on critical care impact.

It was done using a population database in Manitoba, Canada. 49.439 ICU patients admitted over 12 years were compared to hospitalised (n= 146.968) and general (n= 141.937) population.

The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalisation to post-hospitalisation. A high proportion of ICU patients received psychotropic drugs before and after hospitalisation. ICU exposure was associated with mental disorders and sedative-hypnotics use.


STUDY STRENGTHS & LIMITATIONS

Strengths

  • Large population-based cohorts
  • 12-year study period
  • Inclusion of mental disorders from both inpatients and outpatients’ services
  • A broader range of mental disorders than previous studies (not only mood and anxiety disorders)
  • Analysis adjusted for multiple potential confounding variables

Limitations

  • Limited sensitivity and specificity in mental disorders identification
  • Poor information on medication indication and adherence
  • Comorbidity of mental disorders may be underestimated in ICU patients
  • Inclusion of psychiatric hospitalisation may inflate mental disorders in the non- hospitalised population.

TAKE-HOME MESSAGES

ICU stay was associated with higher mental disorder prevalence and psychotropic medication used at one and five years following hospitalisation.

The impact of critical care on patients’ mental wellbeing is essential and needs to be addressed actively by physicians.

This article review was prepared and submitted by Dr Annalisa Lerose, ASST Mantova (IT) on behalf of the ESICM Journal Review Club.


REFERENCES

Olafson K. et al. The 5-year pre- and post-hospitalization treated prevalence of mental disorders and psychotropic medication use in critically ill patients: a Canadian population-based study. Intensive Care Med. 2021 Dec;47(12):1450-1461. doi: 10.1007/s00134-021-06513-z. Epub 2021 Sep 8. PMID: 34495357.

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