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Crit Care Med. 2016 May;44(5):954-65. doi: 10.1097/CCM.0000000000001621.

Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study.

Collaborators (199)

Hudson L, Gundel S, Hough C, Neff M, Sims K, Ungar A, Watkins T, Steingrub J, Tidswell M, Braden E, DeSouza L, Kardos C, Kozikowski L, Ouellette S, Guntupalli K, Bandi V, Pope C, Ross C, Brower R, Fessler H, Hager D, Mendez-Tellez P, Needham D, Oakjones K, Sevransky J, Workneh A, Shanholtz C, Herr D, Howes H, Netzer G, Rock P, Sampaio A, Titus J, Sloane P, Beck T, Highfield D, King S, Lee B, Bolouri N, Wiedemann HP, Ashton RW, Culver DA, Frederick T, Guzman JA, Komara JJ Jr, Reddy AJ, Hejal R, Andrews M, Haney D, Connors AF, Lasalvia S, Thornton JD, Warren EL, Moss M, Burnham EL, Gray L, Maloney J, Mealer M, Douglas I, Overdier K, Thompson K, Wolken R, Frankel S, McKeehan J, Warner ML, Bost T, Higgins C, Hodgin K, MacIntyre N, Brown L, Cox C, Gentile M, Govert J, Knudsen N, Carson S, Chang L, Choudhury S, Hall W, Lanier J, Wheeler AP, Bernard GR, Hays M, Mogan S, Rice TW, Hite RD, Harvey A, Morris PE, Ragusky M, Wright P, Groce S, McLean J, Overton A, Truwit J, Enfield K, Marshall M, Morris A, Grissom C, Austin A, Barney S, Brown S, Ferguson J, Gallo H, Graydon T, Hirshberg E, Jephson A, Kumar N, Lanspa M, Miller R, Murphy D, Orme J, Stowe A, Struck L, Thomas F, Ward D, Bailey P, Beninati W, Bezdjian L, Clemmer T, Rimkus S, Tanaka R, Weaver L, Lawton C, Hanselman D, Sundar K, Alward W, Bishop C, Eckley D, Harris D, Hill T, Jensen B, Ludwig K, Nielsen D, Pearce M, Matthay MA, Calfee C, Daniel B, Eisner M, Garcia O, Kordesch K, Liu K, Shum N, Zhou H, Peterson MW, Blaauw J, Van Gundy K, Kallet R, Johnson E, Albertson T, Morrissey B, Vlastelin E, deBoisblanc B, Antoine A, Charbonnet D, Hunt J, Lauto P, Marr A, Meyaski G, Romaine C, Brierre S, Byrne J, Jagneaux T, LeBlanc C, Moreau K, Thomas C, Jain S, Taylor D, Seoane L, Hebert C, Thompson J, Simeone F, Fearon J, Schoenfeld D, Dong N, Guha M, Hammond E, Lazar P, Morse R, Oldmixon C, Ringwood N, Smoot E, Thompson BT, Wilson R, Harabin A, Bredow S, Waclawiw M, Weinmann G, Spragg RG, Slutsky A, Levy M, Markovitz B, Petkova E, Weijer C, Sznajder J, Begg M, Gilbert-McClain L, Israel E, Lewis J, McClave S, Parsons P.

Author information

1Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 5Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT. 6Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT. 7Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT. 8Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.



To evaluate prevalence, severity, and co-occurrence of and risk factors for depression, anxiety, and posttraumatic stress disorder symptoms over the first year after acute respiratory distress syndrome.


Prospective longitudinal cohort study.


Forty-one Acute Respiratory Distress Syndrome Network hospitals across the United States.


Six hundred ninety-eight acute respiratory distress syndrome survivors.




Psychiatric symptoms were evaluated by using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised at 6 and 12 months. Adjusted prevalence ratios for substantial symptoms (binary outcome) and severity scores were calculated by using Poisson and linear regression, respectively. During 12 months, a total of 416 of 629 patients (66%) with at least one psychiatric outcome measure had substantial symptoms in at least one domain. There was a high and almost identical prevalence of substantial symptoms (36%, 42%, and 24% for depression, anxiety, and posttraumatic stress disorder) at 6 and 12 months. The most common pattern of co-occurrence was having symptoms of all three psychiatric domains simultaneously. Younger age, female sex, unemployment, alcohol misuse, and greater opioid use in the ICU were significantly associated with psychiatric symptoms, whereas greater severity of illness and ICU length of stay were not associated.


Psychiatric symptoms occurred in two thirds of acute respiratory distress syndrome survivors with frequent co-occurrence. Sociodemographic characteristics and in-ICU opioid administration, rather than traditional measures of critical illness severity, should be considered in identifying the patients at highest risk for psychiatric symptoms during recovery. Given high co-occurrence, acute respiratory distress syndrome survivors should be simultaneously evaluated for a full spectrum of psychiatric sequelae to maximize recovery.

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