Predictors of suicidality in critical care ICU patients after discharge: A cross-sectional study.

Abstract

Background: Suicidality is a critical concern among patients recovering from intensive care unit (ICU) admissions due to their heightened vulnerability to psychological stressors and psychiatric illness. Quantitative studies specifically examining how these ICU-related stressors correlate with suicidal ideation remain limited, indicating a critical need for further research in this area.

Aim: This study explores the direct and indirect factors associated with suicidality and predictors of suicidality among patients discharged from the ICU.

Materials and methods: This cross-sectional observational study was conducted at a tertiary care hospital in Uttar Pradesh, India. 315 patients were screened, and 250 adult participants were selected using convenience sampling. These participants were discharged from the medical ICU and recruited during follow-up visits to the psychiatry outpatient department between July 2021 and July 2022. Inclusion criteria encompassed individuals aged 18 years or above who had been discharged within 1 month of ICU stay and provided informed consent. Demographic and clinical variables were collected, including psychiatric diagnoses according to ICD-10 criteria. Suicidality was broadly defined to include suicidal ideation, planning, and attempts. Statistical analyses included Chi-square tests, Structural Equation Modeling (SEM) for direct and indirect associations, and machine learning-based Decision Tree Classification for prediction analysis.

Results: The majority of participants were aged >30 years (83.9%), female (56.4%), and from urban areas (52.8%). Significant associations with suicidality were observed for family history of mental illness (P = 0.004), substance use (P < 0.001), medical comorbidities (P < 0.001), and co-occurring psychiatric illnesses along with depression (P < 0.001). SEM revealed that severe depression, co-occurring psychiatric illnesses, substance use, and extended ICU stays (>7 days) directly influenced suicidality, with past psychiatric history exerting an indirect effect through the severity of depression. Decision tree analysis ranked "more than one co-occurring psychiatric illness along with depression" as the most critical predictor, followed by "duration of ICU stay," "severity of depression," "past psychiatric history," and "substance use history."

Conclusion: This study highlights the complex interplay of clinical and psychiatric factors associated with suicidality among post-ICU patients. The findings underscore the importance of comprehensive psychiatric screening and targeted interventions for high-risk individuals during their recovery phase to mitigate suicide risk.