Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness

Purpose: Some patients who survive intensive care unit (ICU) treatment report psychological sequelae during recovery. This study examined factors associated with psychological outcomes of former ICU patients up to 6 months after hospital discharge. Methods: Participants (n = 195) were adult survivors of ICU enrolled in a multicenter trial of physical rehabilitation after hospital discharge. The 36-Item Short-Form Health Survey (SF-36), the Impact of Events Scale (IES) and the Depression, Anxiety and Stress Scales were completed, and sleep rated on a five-point scale at weeks 1, 8 and 26; clinical and demographic data were obtained from patient records. Results: Participants were 41% females with mean ± standard deviation (SD) age of 57 ± 16 years and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 19 ± 7; median lengths of mechanical ventilation and ICU stay were 89 h and 6 days, respectively. Impaired mental health, depression, anxiety, stress and psychological distress significantly improved after week 1. Female gender, younger age and sleeping problems were associated with impaired psychological outcomes on bivariate analyses. Age; gender; week 1 anxiety, depression and stress; week 26 sleeping; and rehabilitation study group were entered into multiple linear regression analyses for week 26 IES and SF-36 Mental Component Summary (MCS) outcomes. IES scores were associated (p < 0.05) with gender, week 1 stress and week 26 sleep but not study group; MCS scores were associated (p < 0.05) with week 1 stress and week 26 sleep but not study group.Conclusion: Female gender, early levels of increased stress and problems sleeping are associated with worse psychological recovery for survivors of critical illness

A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

Abstract Background Mortality from critical illness is improving, but survivors suffer from prolonged weakness and psychological and cognitive impairments. Maximising the recovery after critical illness has been highlighted as a research priority, especially in relation to an ageing population who present with higher rates of pre-morbid disability. Small studies have shown that starting rehabilitation early within the intensive care unit (ICU) improves short-term outcomes. Systematic reviews have highlighted the need for robust multicentre randomised controlled trials with longer term follow-up. Methods The study design is a randomised controlled study to explore the feasibility of providing earlier and enhanced rehabilitation to mechanically ventilated patients at high risk of ICU-acquired weakness within the ICU. The rehabilitation intervention involves a structured programme, with progression along a functionally based mobility protocol according to set safety criteria. The overall aim of the intervention is to commence mobilisation at an earlier time point in the patient’s illness and increase mobility of the patient through their recovery trajectory. Participants will be randomised to enhanced rehabilitation or standard care, with the aim of recruiting at least 100 patients over 16 months. The trial design will assess recruitment and consent rates from eligible patients, compliance with the intervention, and assess a range of possible outcome measures for use in a definitive trial, with follow-up continuing for 12 months post hospital discharge. Discussion This study will evaluate the feasibility of providing an earlier and enhanced rehabilitation intervention to mechanically ventilated patients in critical care. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a phase III multicentre trial of enhanced rehabilitation for critically ill adults. Trial registration ISRCTN90103222 , 13/08/2015; retrospectively registered

The structure of anxiety and depression in a normative sample of younger and older Australian adolescents

It has been reported that depression and anxiety have overlapping symptoms and are conceptually interrelated. One of the most prominent theoretical developments that explain this association is Clark and Watson’s tripartite model (Journal of Abnormal Psychology, 100:316–336, 1991) that posits these two disorders and negative emotions share a latent component of negative affect (NA). The current study had two aims, (a) to compare a tripartite factor structure against competing models by Confirmatory Factor Analysis (CFA) of the Depression Anxiety and Stress Scales (DASS-21) (Lovibond and Lovibond 1995), and (b) explore the psychometric properties of the DASS-21. The DASS-21 was completed by a representative sample of 4039 young Australians, aged 12–18 years, as part of the South Australian Youth Mental Health Survey (SAYMHS), South Australia, Australia. The best fitting model for the data consisted of anhedonic depression, physiological hyperarousal, and general NA. The psychometric properties of the DASS-21 were excellent with a stable and interpretable factor structure and good internal consistency. The results of the current study suggest that the theoretical tripartite structure of depression and anxiety is robust and applicable among Australian youth. The diagnostic, clinical and theoretical implications of these findings are discussed.Phillip J. Tully, Ian T. Zajac & Anthony J. Vennin

Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers

PURPOSE: Survivors of acute lung injury (ALI) and their informal caregivers have difficulty coping with the physical and emotional challenges of recovery from critical illness. We aimed to develop and pilot test a telephone-based coping skills training intervention for this population. METHODS: 58 participants were enrolled overall. 21 patients and 23 caregivers participated in a cross-sectional study to assess coping and its association with psychological distress. This also informed the development of an ALI coping skills training intervention in an iterative process involving content and methodological experts. The intervention was then evaluated in 7 patients and 7 caregivers in an uncontrolled, prospective, pre-post study. Outcomes included acceptability, feasibility, and symptoms of psychological distress measured with the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Symptom Scale (PTSS). RESULTS: Survivors and their caregivers used adaptive coping infrequently, a pattern that was strongly associated with psychological distress. These findings informed the development of a 12-session intervention for acquiring, applying, and maintaining coping skills. In the evaluation phase, participants completed 77 (92%) of a possible 84 telephone sessions and all (100%) reported that the intervention’s usefulness in their daily routine. Mean change scores reflecting improvements in the HADS (7.8 units) and PTSS (10.3 units) were associated with adaptive coping (r=0.50–0.70) and high self-efficacy (r=0.67–0.79). CONCLUSIONS: A novel telephone-based coping skills training intervention was acceptable, feasible, and may have been associated with a reduction in psychological distress among survivors of ALI and their informal caregivers. A randomized trial is needed to evaluate the intervention