Provider-Documented Anxiety in the ICU: Prevalence, Risk Factors, and Associated Patient Outcomes

Abstract

Purpose: To determine the prevalence of provider-documented anxiety in critically ill patients, associated risk factors, and related patient outcomes. Method: Chart review of 100 randomly sampled, adult patients, with a length of stay ≥48 hours in a medical or trauma/surgical intensive care unit (ICU). Provider-documented anxiety was identified based on a comprehensive retrospective chart review of the ICU stay, searching for any acute episode of anxiety (e.g., documented words related to anxiety, panic, and/or distress). Results: Of 100 patients, 45% (95% confidence interval: 35%-55%) had documented anxiety, with similar prevalence in medical vs. trauma/surgical ICU. Patients with documented anxiety more frequently had history of anxiety (22% vs. 4%, p = .004) and substance abuse (40% vs. 22%, p = .048). In the ICU, they had greater severity of illness (median (IQR) Acute Physiology Score 16(13,21) vs. 13(8,19), p = .018), screened positive for delirium at least once during ICU stay, (62% vs. 31%, p = .002), benzodiazepines and antipsychotics use (87% vs. 58%, p = .002; 33% vs. 13%, p = .013, respectively), and mental health consultation (31% vs. 18%, p = .132). These patients also had longer ICU and hospital lengths of stay (6(4,11) vs. 4(3,6), p<.001 and 18(10,30) vs. 10(6,16) days, p<.001, respectively) and less frequent discharge back to home (27% vs. 44%, p = .079). Conclusions: Documented anxiety, occurring in almost half of ICU patients with length of stay ≥48 hours, was associated with a history of anxiety and/or substance abuse, and greater ICU severity of illness, delirium, psychiatric medications, and length of stay. Increased awareness along with more standardized protocols for assessment of anxiety in the ICU, as well as greater evaluation of non-pharmacological treatments for anxiety symptoms in the ICU are warranted.

More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU

“…We speculated that this anti-gravity position had some beneficial effects; however, further validation is needed. In addition, it has been suggested that the psychological status of critically ill patients might affect the treatment outcomes ( 18 , 19 ) and also considered that the surrounding physical environmental stimulation devices such as lights and alarms present in the ICU environment may further lead to psychological problems such as anxiety and fear ( 20 , 21 ). As a part of psychological support, positive encouragement during mobilization interventions and improvement of one's abilities by maintaining self-confidence to achieve a better recovery might play a key role in a patient's recovery ( 22 , 23 ).…”

Feasibility of Extracting Meaningful Patient Centered Outcomes From the Electronic Health Record Following Critical Illness in the Elderly

“…Mental health diagnoses of depression and anxiety have been explored with EHR looking at some combination of variables such as rates of psychotropic medications, diagnoses codes, referrals for mental health services and in validated tools such as PHQ-9 ( 44 – 46 ). Documentation for anxiety in critical illness reviewing provider notes was found in about 45% of sampled chart reviews with terms such as panic, anxiety , and distress ( 47 ). Capturing PTSD is particularly challenging.…”

A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

“…Despite guidelines suggesting reduced use of benzodiazepines and other sedating medications, hospital and ICU providers have not been provided with evidence or support for helpful alternatives [ 4 ]. Medications remain the most common means of reducing anxiety [ 6 ]. This can have important harmful effects including increased delirium, worsened anxiety, and lengthened ICU and hospital stays [ 39 , 40 ].…”

“…Given decreased sedation, evaluating and addressing psychological distress for ARF patients in the ICU is presumably more feasible and important to consider. Notably, approximately 50% of ARF patients experience clinically significant levels of anxiety in the intensive care unit (ICU) [ 6 , 7 , 8 , 9 ], including feelings of terror, fear of death, loss of control, and eroded sense of self [ 7 , 10 , 11 , 12 ]. Moreover, clinically significant symptoms can be long-lasting after ARF, with 32–40% of survivors having clinically significant anxiety symptoms enduring for months or years [ 3 , 13 ].…”