Prevalence and predictors of psychological morbidity and quality of life after discharge from Intensive Care

PhD Project funded by: MRC

September 2007-September 2010

Key contact: Dorothy Wade
Supervisor panel: Professor Rosalind Raine, Professor John Weinman (Kings College, London) and Dr Rebecca Hardy

As Intensive Care medicine has advanced, the survival rate of patients treated for life-threatening illness has increased. But little is known about the quality of life and well-being of those who survive treatment in Intensive Care. ICU clinicians have reported concern about their patients’ psychological state and patients have described the fear, depression, confusion and agitation they experienced in Intensive Care. There is also some evidence for high rates of psychological morbidity among former ICU patients.

This project is designed to assess patients’ quality of life three months after leaving ICU, and to make accurate estimates of the extent and type of psychological morbidity found in this population. An additional aim of the research is to identify psychological, socio-demographic, clinical and health-care factors that predict adverse psycho-social outcomes in surviving ICU patients.

The investigation has been carried out in 3 parts:

Part 1. A systematic review of observational studies of psycho-social outcomes of ICU patients. The results suggest that posttraumatic stress disorder, anxiety, depression and cognitive impairment, together with poor quality of life, are experienced by a large proportion of patients a few months after discharge from an ICU. However few studies were assessed to be of high quality and sample sizes were often small.

Part 2. A cohort study of 157 Intensive Care patients from University College London Hospitals’ critical care unit. Baseline data were collected on clinical factors including admission pathway and diagnosis, health care factors such as duration of mechanical ventilation, socio-demographic factors such as socio-economic position, and psychological factors such as mood, ICU stress and illness perceptions. At 3 months patients completed validated questionnaires on the following outcomes: PTSD, anxiety, depression and health-related quality of life.

Part 3. In parallel with the main study, a small interview study of 10-20 patients is being conducted to investigate the nature and content of intrusive and delusional memories of Intensive Care, and their role in the genesis of post-ICU psychological morbidity such as PTSD and depression.

For further information, contact Dorothy Wade (email: dorothy.wade@ucl.ac.uk)