| Abstract |
Background: Personal communication restrictions due to the pandemic have made palliative care of Intensive Care Unit (ICU) patients limited and family support more difficult. Even today, the impact of ICU hospitalization on the manifestation of mental disorders such as Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) remains unanswered. For this purpose, the present study was designed to investigate the frequency of MDD and PTSD symptoms in patients hospitalized in an Intensive Care Unit during the pandemic, but also the need to raise awareness and understanding among medical and nursing staff about the needs of these patients after discharge from the ICU.
Objective: To investigate the frequency of symptoms of Major Depressive Disorder and Post-Traumatic Stress Disorder in patients hospitalized in the Intensive Care Unit of the University General Hospital of Heraklion, at the time of the pandemic. To correlate the occurrence of these two mental disorders with demographic and clinical characteristics. Compare the incidence of the frequency of disorders in patients hospitalized with COVID-19 versus patients hospitalized in ICU for another disease.
Methods: This is a cross-sectional design study. The research included patients hospitalized at the University General Hospital of Heraklion, in two Adult Intensive Care Units during the period 1/1/2020 to 1/5/2023. Exclusion criteria included patients with a previous positive psychiatric history, patients who remained in the ICU <24 hours, patients who for any reason were unable to respond to a telephone interview, or those who refused to participate in the survey. In addition, the following were recorded: basic demographic and clinical data of the patient collected through the CRITIS information system and through a telephone interview a questionnaire consisting of 10 closed and open-ended questions based on the manual "MINI: Mini International Neuropsychiatric Interview". "MINI" is a questionnaire containing diagnostic questions about PTSD and MDD as well as questions about their differential diagnosis. The questions have been formulated according to the DSM-IV diagnostic criteria. ‘’MINI’’ is not and is not used as a diagnostic tool but as a screening tool for the development of symptoms of mental illness for which referral to a specialist is indicated. Depending on the outcome, patients were divided into group A, general hospitalization, ICU, and group B, COVID ICU. The samples were combined with simple random sampling and deliberate.
Results: A total of 100 ICU patients with or without COVID-19 were included in the study. 67 were male and 33 were female, with a mean age of 64.2 (SD=14.8). The rates of MDD (27.8%) and PTSD (33%) did not differ significantly between patients with and without COVID-19. Patient comorbidity was high (78%) and did not differ between the two groups. The sample was not recruited equally between COVID-19 (28%) and non-COVID-19 (72%) ICU patients. More frequently, COVID-19 patients were supported with HFNC (21.4% vs. 1.4%) or invasive ventilation (78.6% vs. 73.6%) compared to non-COVID-19 patients in ICU (p<0.001). The duration of support with mechanical ventilation (p<0.001) as well as the duration of ICU hospitalization (p=0.003) were significantly longer in patients with COVID-19 compared to patients without COVID-19. The results of the questions related to PTSD showed fear or trepidation or despair to be significantly more frequent in the group hospitalized with COVID-19 in the ICU compared to the group without COVID-19 (5.7 vs. 3.3, p=0.043). Symptoms such as melancholy (AUC 0.885, p<0.001), its duration (AUC 0.904, p<0.001), and daily lack of interest (AUC 0.736, p=0.001), showed a strong predictive ability for the occurrence of MDD in ICU patients regardless of the cause of admission. The presence of problems affecting their work and social life causing distress (AUC 0.885 p<0.001) could significantly predict PTSD in all patients.
Conclusions: One-fourth of patients with or without COVID-19 present with MDD and one-third present with PTSD within about 2 years of their discharge from the ICU. Among various emotions, fear or despair are what characterizes patients who have been hospitalized with COVID-19. The feeling of melancholy, its duration, and lack of interest in things, as compared to their previous interests, are associated with the development of MDD in all patients. The presence of problems that affect work and social life are associated with the possibility of developing PTSD in patients who have been hospitalized in ICU with or without COVID-19.
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