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Original Research: CRITICAL CARE MEDICINE |

Self-Reported Symptoms of Depression and Memory Dysfunction in Survivors of ARDS

Neill K. J. Adhikari, MDCM, MSc; Mary Pat McAndrews, PhD; Catherine M. Tansey, MSc; Andrea Matté, BSc; Ruxandra Pinto, PhD; Angela M. Cheung, MD, PhD; Natalia Diaz-Granados, MSc; Aiala Barr, PhD; Margaret S. Herridge, MD, MPH
Author and Funding Information

*From the Interdepartmental Division of Critical Care and Department of Medicine (Drs. Adhikari and Herridge), University of Toronto; Department of Critical Care Medicine (Dr. Pinto), Sunnybrook Health Sciences Centre; Krembil Neuroscience Program (Dr. McAndrews), University Health Network; Medical-Surgical Intensive Care Unit (Ms. Tansey and Ms. Matté), University Health Network; Department of Medicine (Dr. Cheung), University of Toronto; Women's Health Program (Ms. Diaz-Granados), University Health Network; and Department of Public Health Sciences (Dr. Barr), University of Toronto, Toronto, ON, Canada.

Correspondence to: Neill K. J. Adhikari, MDCM, MSc, Department of Critical Care Medicine, Room D1.08, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5; e-mail: neill.adhikari@utoronto.ca


This study was supported by Physicians' Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation.

All authors declare that no financial or other potential conflicts of interest exist. Dr. Adhikari had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):678-687. doi:10.1378/chest.08-0974
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Background:  Survivors of ARDS have well documented physical limitations, but psychological effects are less clear. We determined the prevalence of self-reported depression and memory dysfunction in ARDS survivors.

Methods:  Six to 48 (median 22) months after ICU discharge, we administered instruments assessing depression symptoms (Beck Depression Inventory-II [BDI-II]) and memory dysfunction (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 82 ARDS patients who were enrolled in a prospective cohort study in four university-affiliated ICUs.

Results:  Sixty-one (74%), 64 (78%), and 61 (74%) patients fully completed the BDI-II, MAC-S (Ability subscale), and MAC-S (Frequency of Occurrence subscale) instruments. Responders (similar to nonresponders) were young (median 42 years, interquartile range [IQR] 35 to 56), with high admission illness severity and organ dysfunction. The median BDI-II score was 12 (IQR 5 to 25). Twenty-five (41%) patients reported moderate-severe depression symptoms and were less likely to return to work than those with minimal-mild symptoms (8/25 [32%] vs 25/36 [69%]; p = 0.005). Median MAC-S (Ability) and MAC-S (Frequency of Occurrence) scores were 76 (IQR 61 to 93) and 91 (IQR 77 to 102), respectively; 8%, 16%, and 20% scored > 2, > 1.5, and > 1 SD(s), respectively, below age-adjusted population norms for each subscale. BDI-II and MAC-S scores were negatively correlated (Spearman coefficient –0.58 and –0.50 for Ability and Frequency of Occurrence subscales, respectively; p < 0.0001). Univariable analyses showed no demographic or illness-severity predictors of BDI-II (including the Cognitive subscale) or MAC-S (both subscales); results were similar when restricted to patients whose primary language was English.

Conclusions:  ARDS survivors report a high prevalence of depression symptoms and a lower prevalence of memory dysfunction 6 to 48 months after ICU discharge. Depression symptoms may hinder the return to work, or patients may report these symptoms because of inability to re-enter the workforce.

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