Review ArticleAnxiety symptoms in survivors of critical illness: a systematic review and meta-analysis☆
Introduction
With recent medical advances, the number of survivors of critical illness is increasing [1]. There are a growing number of studies evaluating survivors' outcomes after hospital discharge [2]. Critical illness survivors frequently face complicated recovery processes, including long-term impairments in physical and cognitive function, and quality of life [3], [4]. Psychiatric symptoms in critical illness survivors are associated with decreased quality of life [5], [6], [7]. Recently, there has been increased interest in the mental health outcomes of critical illness survivors [5], [6], [7]. Recent systematic reviews have focused on different aspects of mental health in this population, such as posttraumatic stress disorder (PTSD) [5] and depression [7]. However, to our knowledge, no published systematic review has examined nonspecific anxiety symptoms in critical illness survivors. Hence, our objectives were to (a) examine the prevalence of anxiety symptoms in critical illness survivors; (b) evaluate the natural history and change in symptom severity during the first year after critical illness; (c) identify preintensive care unit (ICU), ICU and post-ICU risk factors; and (d) assess post-ICU interventions for prevention or treatment of anxiety symptoms following critical illness.
Section snippets
Search strategy
To identify eligible studies, we searched five electronic databases (PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO®, EMBASE and the Cochrane Controlled Trials Registry) from 1970 through March 2015. We searched for articles with any patient outcome assessment after hospital discharge in survivors of critical illness, since articles may measure anxiety symptoms as part of a battery of assessments of other outcomes. Our keywords for the database searches focused on
Description of search and study characteristics
We identified 27,334 citations, and after removing the duplicates, we reviewed 18,693 unique titles and abstracts and 1579 full-text articles. A total of 27 unique studies from 29 publications (Fig. 1) met our eligibility criteria. All studies were published on or after the year 2000. These studies included 8 RCTs [14], [15], [16], [17], [18], [19], [20], [21], 15 cohort studies [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36] and 4 cross-sectional
Discussion
Our systematic review and meta-analysis of 27 studies with 2880 general ICU survivors demonstrate a prevalence of anxiety symptoms of 32–40% over 1-year follow-up. Studies with longitudinal assessment of the same population of ICU survivors showed no significant change in HADS-A scores or prevalence during the first year after discharge.
The reported anxiety symptoms across different studies ranged from 5 to 73%. This variability may be due to differences in patient populations, anxiety
Conclusion
In this meta-analysis of 27 studies with 2880 general ICU survivors, we found that at least one third of ICU survivors experience anxiety symptoms that persist during the first year after critical illness. Many traditional ICU factors, such as severity of illness and LOS, were not associated with anxiety symptoms. Psychiatric symptoms in the hospital and memories of delusional experiences while critically ill were associated with anxiety at post-ICU follow-up. No post-ICU interventions had
Acknowledgments
We thank the following investigators who provided additional data from their research studies to permit this meta-analysis: Drs. Ceri Battle, Brian Cuthbertson, Maité Garrouste-Orgeas, Richard Griffiths, Christina Jones, David McWilliams, Hilde Myhren, Giles Peek, Janice Rattray, Anna Schandl, Kannika Sukantarat, Marike van der Schaaf and Timothy Walsh. We also thank the following people for their assistance in literature searches, screening titles and abstracts, data collection and management:
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Source of Funding: This research was supported by the National Heart, Lung and Blood Institute [R24HL111895].