0
Original Research |

Self-reported Depressive Symptoms and Memory Complaints in Survivors Five Years After ARDS201CDepression and Memory Complaints After ARDS201D

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

From the Interdepartmental Division of Critical Care (Drs Adhikari and Herridge), University of Toronto, Toronto; Department of Critical Care Medicine (Drs Adhikari and Pinto), Sunnybrook Health Sciences Centre, Toronto; Department of Medicine (Drs Tansey, Cheung, and Herridge and Ms Matté), Krembil Neuroscience Centre (Dr McAndrews), and Women’s Health Program (Dr Cheung and Ms Diaz-Granados), University Health Network, Toronto; Department of Medicine (Drs Cheung and Herridge) and Department of Health Policy, Management and Evaluation and the Dalla Lana School of Public Health (Dr Cheung), University of Toronto, Toronto; and Department of Clinical Epidemiology and Biostatistics (Ms Diaz-Granados), McMaster University, Hamilton, ON, Canada.

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

Data are presented as median (first-third quartile) or No. (%). The 48 responders returned either a BDI-II or MAC-S questionnaire. APACHE = Acute Physiology and Chronic Health Evaluation; BDI-II = Beck Depression Inventory II; LIS = Lung Injury Score; MAC-S = Memory Assessment Clinics Self-Rating Scale; MODS = Multiple Organ Dysfunction Score.

a

n = 47.

b

The LIS included the sum of the chest radiography, hypoxemia, and positive end-expiratory pressure scores, while excluding static compliance.

c

n = 45.

d

n = 9.

Data are presented as median (first-third quartile) or No. (%). Percentages may not sum to 100% because of rounding. The two n values in the first column refer to the earlier questionnaires (completed at a median of 22 months [range, 6-48 months] following ICU discharge for BDI-II and MAC-S10 and 2 y for SF-36) and the 5-y questionnaires, respectively. Of 64 survivors evaluated at 5 y, 48 patients answered either the BDI-II or the MAC-S; data for the earlier time point includes only patients who also completed the 5-y questionnaires. Comparisons between 5-y and earlier scores were made using Wilcoxon signed rank test (continuous variables) and exact McNemar test (categorized scores) and only included patients who contributed data at both time points. MCS = mental component summary; MH = mental health; RE = role emotional; SF-36 = Medical Outcomes Study 36-Item Short Form. See Table 1 legend for expansion of other abbreviations.

a

At 5 y (n = 48), two patients did not answer BDI-II, and three had missing items; at the earlier administration, two did not answer, and three had missing items.

b

Depression categories are from the BDI-II scale. The P value refers to the comparison of minimal to mild vs moderate to severe categories at 5 y vs the earlier assessment.

c

At 5 years (n = 48), one patient did not answer, and one had a missing item; at the earlier administration, one did not answer, and five had missing items.

d

Proportion of sample < 2, < 1.5, or < 1 SD below age-adjusted US sample mean.14 We used patients’ ages at questionnaire completion.

e

At 5 y (n = 48), one patient did not answer, and nine had missing items; at the earlier assessment, one did not answer, and five had missing items.

f

At 5 y (n = 48), one patient did not answer, and three, one, and four patients had missing items for RE, MH, and MCS, respectively. At the earlier assessment, eight patients did not answer, and one and two patients had missing items for RE and MCS, respectively.

g

Proportion of sample < 2, < 1.5, or < 1 SD below age- and sex-matched Canadian sample mean.21 We used patients’ ages at questionnaire completion.

See Table 1 and 2 legends for expansion of abbreviations.

Predictor variables refer to the index ICU admission (except for age, which is at the time of questionnaire administration). Unadjusted analyses included questionnaires with no missing items (n = 43 except for APACHE II [n = 42]). Separately for each predictor, we also included the earlier BDI-II score and the number of months between BDI-II administrations (n = 38 except for APACHE II [n = 37]) in an adjusted analysis. All BDI-II scores were log-transformed. We added 0.5 to 0 scores before taking the logarithm (n = 4 at 5 y in unadjusted analyses; n = 3 at 5 y and n = 3 for the earlier questionnaire in adjusted analyses). Positive (negative) β coefficients imply that the predictor is associated with higher (lower) log-transformed BDI-II scores. In adjusted analyses, β values for the earlier BDI-II score ranged from 0.39 to 0.46 and were highly significant (P = .003-.015); β values for the time between administrations were small and not statistically significant. In sensitivity analyses calculating adjusted scores for questionnaires with missing items, results are similar. See Table 1 and 2 legends for expansion of abbreviations.

a

The change in MODS over time during ICU admission is expressed as the slope of the score.

b

The change in LIS over time during ICU admission is expressed as the slope of the score.

c

The logarithm of this variable was used because the untransformed variable had a skewed distribution.

Predictor variables refer to the index ICU admission (except for age, which is at the time of questionnaire administration). Unadjusted analyses include questionnaires with complete data (n = 46 for ability subscale except for APACHE II [n = 45]; n = 38 for frequency of occurrence subscale). Separately for each predictor, we also included the earlier MAC-S score and the number of months between MAC-S administrations in an adjusted analysis. For the ability subscale, adjusted analyses (n = 39 for all except APACHE II [n = 38]) excluded one case with high residuals. For the frequency of occurrence subscale, adjusted analyses (n = 30) excluded three cases with high residuals. Positive (negative) β coefficients imply that the predictor is associated with higher (lower) MAC-S scores. In adjusted analyses, β values for the earlier MAC-S score ranged from 0.84 to 0.94 and were highly significant (all P < .0001); β values for the time between administrations were small and not statistically significant. See Table 1 and 2 legends for expansion of abbreviations.

a

In a sensitivity analysis calculating adjusted scores for questionnaires with missing items, results were similar, but female sex was no longer significant in the adjusted analysis.

b

The change in MODS over time during ICU admission is expressed as the slope of the score.

c

The change in LIS over time during ICU admission is expressed as the slope of the score.

d

The logarithm of this variable was used because the untransformed variable had a skewed distribution.

e

In a sensitivity analysis including the three cases with high residuals, the adjusted analyses showed a significant effect of female sex (β, −11.60; SE, 4.60; P = .02). However, this effect was no longer significant if questionnaires with missing items were included by calculating adjusted scores.

Funding/Support: This work was performed at the University of Toronto and was supported by Physicians’ Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation. Dr Cheung is supported by a Canadian Institutes of Health Research Senior Investigator Award and the Lillian Love Chair in Women’s Health at the University of Toronto and University Health Network.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This work was performed at the University of Toronto and was supported by Physicians’ Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation. Dr Cheung is supported by a Canadian Institutes of Health Research Senior Investigator Award and the Lillian Love Chair in Women’s Health at the University of Toronto and University Health Network.

Funding/Support: This work was performed at the University of Toronto and was supported by Physicians’ Services Incorporated, Ontario Thoracic Society, and Canadian Intensive Care Foundation. Dr Cheung is supported by a Canadian Institutes of Health Research Senior Investigator Award and the Lillian Love Chair in Women’s Health at the University of Toronto and University Health Network.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1484-1493. doi:10.1378/chest.11-1667
Text Size: A A A
Published online

Background:  Survivors of ARDS report depressive symptoms and memory complaints, the prevalence of which after 5 years is unknown.

Methods:  We administered instruments assessing symptoms of depression (Beck Depression Inventory II [BDI-II]) and memory complaints (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 64 survivors of ARDS from four university-affiliated ICUs 5 years after ICU discharge. We compared BDI-II scores to quality of life (Medical Outcomes Study 36-Item Short Form [SF-36]) mental health domains (role emotional, mental health, mental component summary), compared BDI-II and MAC-S scores to earlier scores (median, 22 months postdischarge), and examined return to work.

Results:  Forty-three (67.2%), 46 (71.9%), and 38 (59.4%) patients fully completed the BDI-II, MAC-S ability subscale, and MAC-S frequency of occurrence subscale, respectively. Responders were young (median, 48 years; first-third quartile [Q1-Q3], 39-61 years) with high illness severity. The median BDI-II score was 10 (Q1-Q3, 3-18); eight of 43 (18.6%) had moderate to severe depressive symptoms compared with 14 of 43 (32.6%) earlier (P = .15, n = 38 with paired data). Median MAC-S ability and MAC-S frequency scores were 81 (Q1-Q3, 57-92) and 91.5 (Q1-Q3, 76-105), respectively, similar to earlier scores (P = .67 and P = .64, respectively); 0% to 4.3% scored > 2 SDs below population norms. Higher BDI-II score was predicted by higher earlier BDI-II score, slower recovery of organ function, and longer duration of mechanical ventilation and ICU stay. Higher MAC-S score was predicted by higher earlier MAC-S score. SF-36 mental health domain scores were very stable (P = .57-.83). BDI-II and SF-36 mental health domains were negatively correlated (Spearman coefficient, −0.50 to −0.82). Most patients returned to work regardless of depressive symptoms (minimal to mild, 31 of 35 [88.6%]; moderate to severe, five of eight [62.5%]; P = .12).

Conclusions:  Compared with ∼ 2 years postdischarge from the ICU, depressive symptoms and memory complaints were similar at 5 years. Mental health domains of the SF-36 may not be sensitive to small changes in mood symptoms.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Guidelines
Detection and assessment of late life anxiety.
University of Iowa College of Nursing, John A. Hartford Foundation Center of Geriatric Nursing Excellence | 9/25/2009
Mood, memory, and cognition. In: Menopause and osteoporosis update 2009.
Society of Obstetricians and Gynaecologists of Canada | 6/12/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543