Trait Anxiety But Not State Anxiety During Critical Illness Was Associated With Anxiety and Depression Over 6 Months After ICU

Abstract

Citation: Castillo, M. I., Cooke, M. L., Macfarlane, B. & Aitken, L. M. (2015). Trait anxiety but not state anxiety during critical Illness was associated with anxiety and depression over 6 months after ICU. Critical Care Medicine, 44(1), pp. 100-110. doi: 10.1097/CCM.0000000000001356 This is the accepted version of the paper.This version of the publication may differ from the final published version. Griffith University and Princess Alexandra Hospital Intensive Care Unit, Brisbane, Queensland, Australia. Permanent repository link Reprints:Reprints will not be ordered. Financial support:Intensive Care Foundation Research Grant and Australian College of Critical CareNurses Research Grant. KeywordsIntensive care unit, state anxiety, trait anxiety, critically ill, anxiety, depression. Interventions: None. Measurements and Main Results:The outcomes of symptoms of anxiety and depression over six months after ICU discharge were assessed using the Hospital Anxiety Depression Scale. The primary variable of interest was anxiety during critical illness. Two components of anxiety (state and trait) were assessed during critical illness using the Faces Anxiety Scale and the trait component of the State-Trait Anxiety Inventory. Perceived social support, cognitive functioning and post-traumatic stress symptoms were also assessed using standardised instruments. Clinical and demographic data were obtained from patients and medical records. Participants were followed-up in hospital wards, and at three and six months after ICU discharge.During ICU treatment, 81 (57%) of the 141 participants reported moderate to severe levels of state anxiety. Of the 92 participants who completed the surveys at the six-month follow-up, 26 (28%) reported symptoms of anxiety and 21 (23%) symptoms of depression. Symptoms of anxiety and depression were strongly 4 correlated in this cohort of survivors. Trait anxiety was significantly associated with both anxiety and depression symptoms over time, however, state anxiety was not associated with either outcome. Participants who reported post-ICU memories of intra-ICU anxiety were significantly more anxious during recovery over six months.Cognitive functioning and post-traumatic stress symptoms were both significantly associated with anxiety and depression symptoms over time. Conclusion:Symptoms of anxiety and depression are a significant issue for general ICU survivors. Trait anxiety was significantly associated with adverse emotional outcomes over six months after ICU discharge. There was also a significant relationship between post-ICU memories of intra-ICU anxiety and anxiety during recovery. Interventions to reduce anxiety during critical illness need to be considered and evaluated for their longer term benefits for survivors of critical illness.

Factors associated with anxiety in critically ill patients: A prospective observational cohort study

“…Recent reports have shown a relationship between trait anxiety and symptoms of anxiety, depression and posttraumatic stress disorder in intensive care survivors (Castillo et al, 2015a, Castillo et al, 2015b. These findings are in line with previous reports in other populations such as survivors of rectal cancer (Ristvedt and Trinkaus, 2009).…”

“…Participants in this analysis were enrolled in a prospective follow-up study that investigated anxiety, depression and posttraumatic stress symptoms in intensive care survivors over six months after discharge from the intensive care unit (Castillo et al, 2013, Castillo et al, 2015a, Castillo et al, 2015b. Participants (n=141) were from one closed mixed medical/surgical/trauma intensive care unit of a tertiary metropolitan public hospital located in Brisbane, Australia.…”

Perspectives of patients and family members regarding psychological support using intensive care diaries: An exploratory mixed methods study

“…First, attrition rates between recruitment at the end of ICU admission and follow-up were high (ICU patients 43%; family members 48%). However, these rates of attrition are similar to other recent longitudinal studies of ICU survivors [36,37]. There was no discernible difference in the demographic and clinical characteristics of the patients who completed the study compared to those who did not.…”

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

“…First, because of lack of data on pre-ICU anxiety symptoms, the incidence of post-ICU anxiety symptoms cannot be assessed. Measuring baseline anxiety should be a priority for future studies, when feasible (52). Second, all studies used questionnaires to assess anxiety symptoms.…”