Psychological interventions may reduce the mental health problems experienced by many intensive care patients, according to University College London researchers.
The researchers in a new study found that more than half of those who were discharged from intensive care went on to suffer psychological problems.
Researchers further investigated the causes of poor mental health in certain intensive care unit (ICU) patients once they were back home and supposedly “well.”
The study looked at four groups of risk factors (clinical, acute psychological, socio-demographic and chronic health) during the ICU admissions of 157 patients.
Three months after hospital discharge, the patients were assessed to see if they had any symptoms of post traumatic stress disorder (PTSD), depression or anxiety.
While certain drug treatments were identified as clinical risk factors for psychological problems, it was discovered that having acute stress reactions while in intensive care was an even stronger risk factor.
“The research showed associations between sedative drugs such as benzodiazepines, the length of time a patient was sedated and the likelihood of them feeling depressed, anxious and traumatized in future.
“However we found that acute stress reactions felt by a patient in the ICU was an even stronger risk factor,” said Dr. David Howell, clinical director of critical care at University College Hospital.
“As well as looking at modifying our drug treatments, we may need to invest more time in the psychological care of a patient and find ways to prevent psychological suffering in the ICU which can affect the quality of their life in years to come.”
The study found that “level three” patients — those who received mechanical ventilation for over 24 hours or had had two or more organs supported — suffered considerable mental stress both during and after a general ICU admission.
Three months after a hospital discharge, 27 percent had probable PTSD, 46 percent had probable depression and 44 percent had anxiety.
The strongest risk factors were as follows: duration of sedation (for PTSD); use of benzodiazepines (for depression); use of inotropes and vasopressors (for anxiety) and use of steroids (predicting better physical quality of life).
The most notable finding, however, was that acute stress reactions in the ICU were stronger risk factors than clinical factors.
“Our hypothesis is that patients suffer stress and delirium in the ICU due to invasive treatments and powerful drugs received, and those who suffer those stress reactions are more likely to have adverse psychological outcomes in the long-term,” said Dr. Dorothy Wade, health psychologist in critical care at University College Hospital.
A short psychological questionnaire, called the I-PAT (Intensive Care Psychological Assessment Tool), which is used by nurses to assess any changes in the mental well-being of patients, is now being validated by Wade and her colleagues in the critical care unit.
Furthermore, a variety of methods including relaxation, breathing exercises and therapeutic approaches are used to help patients feel safe and more assured. Picture prompts, wearing eye masks and playing soft music can also diminish patients’ distress.
“These are all relatively simple interventions which staff can undertake at the bedside as part of holistic care,” said Wade.
More funding is needed, however, to investigate the effects of these techniques on a patient’s long-term mental wellbeing.
“Research into psychological recovery from critical care is vitally important and more needs to be done. We’re really proud of this study and our work developing the I-PAT, and excited about the next step, which is to examine the effects of psychological interventions while patients are in critical care,” said Howell.
The research is published in the journal Critical Care.
Source: University College London