Pre‐existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta‐analysis of prevalence

Pilowsky, Julia; Elliott, Rosalind; Roche, Michael

doi:10.1111/jan.14753

Cited by 9 publications

(8 citation statements)

References 69 publications

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“…Our findings have potential implications for clinical practice, particularly for critically ill patients with pre-existing mental health disorders. A previous systematic review demonstrated that ~19% of adults in ICU suffer from such conditions, making them a significant subgroup [ 39 ]. Among the medications prescribed for mental health disorders, SSRIs are commonly used, including for depression, anxiety, and posttraumatic stress disorders [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Pre-intensive care unit use of selective serotonin reuptake inhibitors and mortality in critically ill adults with mental disorders: analysis from the MIMIC-IV database

Zhang

Wang

et al. 2023

Transl Psychiatry

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Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed drugs for mental disorders in critically ill patients. We performed a retrospective cohort study to investigate the association between pre-ICU use of SSRIs and mortality in critically ill adults with mental disorders. We identified critically ill adults with mental disorders based on the Medical Information Mart in Intensive Care-IV database. The exposure was the use of SSRIs during the period after hospital admission and before ICU admission. The outcome was in-hospital mortality. Time-dependent Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) with 95% confidence interval (CI). To further test the robustness of the results, we performed propensity score matching and marginal structural Cox model estimated by inverse probability of treatment weighting. The original cohort identified 16601 patients. Of those, 2232 (13.4%) received pre-ICU SSRIs, and 14369 (86.6%) did not. Matched cohort obtained 4406 patients, with 2203 patients in each group (SSRIs users vs. non-users). In the original cohort, pre-ICU use of SSRIs was associated with a 24% increase in the hazard for in-hospital mortality (aHR, 1.24; 95% CI, 1.05–1.46; P = 0.010). The results were robust in the matched cohort (aHR, 1.26; 95% CI, 1.02–1.57; P = 0.032) and the weighted cohort (aHR, 1.43; 95% CI, 1.32–1.54; P < 0.001). Pre-ICU use of SSRIs is associated with an increase in the hazard for in-hospital mortality in critically ill adults with mental disorders.

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Section: Discussionmentioning

confidence: 99%

Pre-intensive care unit use of selective serotonin reuptake inhibitors and mortality in critically ill adults with mental disorders: analysis from the MIMIC-IV database

Zhang

Wang

et al. 2023

Transl Psychiatry

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“…Inequity in access to treatment and care contribute to overrepresentation of people with mental illness among people presenting with chronic and critical illnesses and an excess mortality (Pilowsky et al, 2021 ). Recognition of longstanding inequities and immense social and economic burden underpin calls internationally to improve healthcare for this population (Lawrence & Kisely, 2010 ; Mitchell et al, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity

Flaws,

Patterson,

Bagshaw

et al. 2023

Nursing Open

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AimTo address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour.People living with mental illness are over‐represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness.Design & MethodsA discursive paper, drawing on clinical experience and research of the authors and current literature.ResultsLike all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co‐morbid mental illness, a history of trauma and social disadvantage.By identifying and sensitively addressing patients' underlying needs in a trauma‐informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery.Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self‐care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support—informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients.Relevance to clinical practiceICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well‐being while providing this care.Patient and public involvementThis paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution.

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“…The impact of PMHDs on the long-term physical and mortality outcomes of ICU survivors is also well studied (12)(13)(14). However, the extent to which PMHDs exacerbate an episode of critical illness is poorly understood (15). The current study therefore aimed to determine the prevalence and types of PMHDs in patients admitted to an adult ICU using natural language processing (NLP) and investigated associations between the presence of a PMHD and ICU outcomes such as ICU length of stay and need for invasive ventilation.…”

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confidence: 99%

Association Between Preexisting Mental Health Disorders and Adverse Outcomes in Adult Intensive Care Patients: A Data Linkage Study

Pilowsky

Elliott²,

Roche

2023

Critical Care Medicine

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OBJECTIVES: Mental illness is known to adversely affect the physical health of patients in primary and acute care settings; however, its impact on critically ill patients is less well studied. This study aimed to determine the prevalence, characteristics, and outcomes of patients admitted to the ICU with a preexisting mental health disorder. DESIGN: A multicenter, retrospective cohort study using linked data from electronic ICU clinical progress notes and the Australia and New Zealand Intensive Care Society Adult Patient Database. SETTING/PATIENTS: All patients admitted to eight Australian adult ICUs in the calendar year 2019. Readmissions within the same hospitalization were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Natural language processing techniques were used to classify preexisting mental health disorders in participants based on clinician documentation in electronic ICU clinical progress notes. Sixteen thousand two hundred twenty-eight patients (58% male) were included in the study, of which 5,044 (31.1%) had a documented preexisting mental health disorder. Affective disorders were the most common subtype occurring in 2,633 patients (16.2%), followed by anxiety disorders, occurring in 1,611 patients (9.9%). Mixed-effects regression modeling found patients with a preexisting mental health disorder stayed in ICU 13% longer than other patients (β-coefficient, 0.12; 95% CI, 0.10–0.15) and were more likely to experience invasive ventilation (odds ratio, 1.42; 95% CI, 1.30–1.56). Severity of illness and ICU mortality rates were similar in both groups. CONCLUSIONS: Patients with preexisting mental health disorders form a significant subgroup within the ICU. The presence of a preexisting mental health disorder is associated with greater ICU length of stay and higher rates of invasive ventilation, suggesting these patients may have a different clinical trajectory to patients with no mental health history. Further research is needed to better understand the reasons for these adverse outcomes and to develop interventions to better support these patients during and after ICU admission.

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Pre‐existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta‐analysis of prevalence

Cited by 9 publications

References 69 publications

Pre-intensive care unit use of selective serotonin reuptake inhibitors and mortality in critically ill adults with mental disorders: analysis from the MIMIC-IV database

Pre-intensive care unit use of selective serotonin reuptake inhibitors and mortality in critically ill adults with mental disorders: analysis from the MIMIC-IV database

Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity

Association Between Preexisting Mental Health Disorders and Adverse Outcomes in Adult Intensive Care Patients: A Data Linkage Study

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