Factors associated with anxiety and depression one year after trauma critical care admission: A multi-centre study.

Abstract

Background: Recovery after severe injury may be impacted by a range of psychological factors. This multi-site study investigated the prevalence and impact of anxiety and depression at one year after trauma critical care admission.

Methods: Adult trauma patients admitted to four Level 1 Critical Care Units were prospectively enrolled over 18 months. Survivors were followed-up at one year post discharge using EQ-5D-5L questionnaires. Multivariable logistic regression analysis was used to evaluate factors associated with anxiety and depression at follow up.

Results: Of the 657 patients consented and alive at follow-up, 290 questionnaires were completed (44 % response rate). Two-thirds (63 %) reported anxiety or depression (AoD) at follow up, and this was associated with a worse overall health state (EQ-VAS No AoD: 80 vs. AoD: 60, p < 0.0001). Median ISS in both groups was 25 but those with AoD were younger (53 years vs. 60 years, p = 0.033), had previous psychological morbidities (16 % vs. 5 %, p = 0.0056) and longer hospital stays (32 vs. 24 days, p = 0.0027). All physical EQ-5D-5 L domains were worse in the presence of AoD and problems increased as anxiety or depression became more severe. Factors associated with anxiety and depression were younger age (OR 0.98 [95 % CI 0.96-0.99] p = 0.004), previous psychological morbidity (OR 3.30 [95 % CI 1.51-7.40] p = 0.004), penetrating injury (OR 10.10 [95 % CI 1.90 - 44.4] p = 0.007), ongoing pain (OR 1.61 [95 % CI 1.10-2.30] p = 0.003) or difficulties carrying out usual activities (OR 1.40 [95 % CI 1.02-2.29] p = 0.04).

Conclusion: Anxiety and depression are significant longer-term impacts after severe injury. Younger age, penetrating injury and psychological comorbidities may be identifiers of longer-term anxiety and depression following trauma critical care. Pain at one-year had a strong association and represents a modifiable target to improve psychological outcomes.