Employment status and its associated factor for patients 12 months after intensive care: Secondary analysis of the SMAP-HoPe-study

Abstract

Returning to work is a serious issue that affects patients who are being discharged from the intensive care unit (ICU). This study aimed to clarify the employment status and the perceived household financial status of ICU patients 12 months following discharge from the ICU. Additionally, a hypothesis of whether depressive symptoms were associated with subsequent unemployment status was tested. This study was a subgroup analysis using data from the published Survey of Multicenter Assessment with Postal questionnaire for Post-Intensive Care Syndrome (PICS) for Home Living Patients (the SMAP-HoPe study) in Japan. The patients included those who had a history of staying in the ICU for at least three nights and had been living at home for one year following discharge, between October 2019 and July 2020. We assessed employment status, subjective cognitive functions, household financial status, Hospital Anxiety and Depression Scale scores, and EuroQOL-5 dimensions of physical function at 12 months following intensive care. This study included 328 patients who were known to be employed prior to ICU admission. The median age was 64 (Interquartile Range [IQR] 52-72), and males were predominant (86%). Seventy-nine (24%) of those evaluated were unemployed. The number of patients who reported worsened financial status was significantly higher in the unemployed group. (p<.01) Multivariate analysis showed that higher age (Odds Ratio [OR]: 1.06, 95% Confidence Interval [CI]: 1.03-1.08]) and severity of depressive symptoms (OR: 1.13 [95% CI: 1.05-1.23]) were independent factors for employment status after 12 months from being discharged from the ICU. These factors were determined to be significant even after adjusting for sex, physical function, and cognitive function. We found that one-fourth of our patients who had been employed prior to ICU admission were subsequently unemployed 12 months following ICU discharge. Additionally, depressive symptoms were associated with unemployment status. The government and the local municipalities should provide medical and financial support to such patients. Additionally, community support for such patients is warranted.