Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with >= 24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p <=.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444. Clinically significant depressive and post-traumatic stress disorder symptoms in survivors of COVID-19 critical illness, especially in patients who had undergone invasive mechanical ventilation, were highly frequent, occurred soon after discharge, and persisted over the long term. Antecedentes: El ingreso en la unidad de cuidados intensivos (UCI) y la ventilaci & oacute;n mec & aacute;nica invasiva (VMI) se asocian con malestar psicol & oacute;gico y trauma. La pandemia de COVID-19 trajo consigo una serie de experiencias estresantes y traum & aacute;ticas adicionales de larga duraci & oacute;n. Sin embargo, se sabe poco sobre la depresi & oacute;n y el trastorno de estr & eacute;s postraum & aacute;tico (TEPT) com & oacute;rbidos.Objetivo: Examinar la aparici & oacute;n, coexistencia, y persistencia de s & iacute;ntomas cl & iacute;nicamente significativos de depresi & oacute;n y TEPT, y sus factores predictivos, en supervivientes de enfermedad cr & iacute;tica por COVID-19.M & eacute;todo: Estudio observacional prospectivo unic & eacute;ntrico en adultos supervivientes de COVID-19 con >= 24 h de ingreso en UCI. Los pacientes fueron evaluados uno y 12 meses despu & eacute;s del alta de UCI mediante la subescala de depresi & oacute;n de la Escala Hospitalaria de Ansiedad y Depresi & oacute;n y la Escala de Trauma de Davidson. Se analizaron las diferencias en los s & iacute;ntomas aislados y com & oacute;rbidos de depresi & oacute;n y TEPT entre pacientes con y sin VMI y los predictores de la aparici & oacute;n y persistencia de s & iacute;ntomas de estos dos trastornos mentales.Resultados: Ochenta y nueve pacientes (42 con VMI) completaron el seguimiento de 1 mes y 71 (34 con VMI) completaron el seguimiento de 12 meses. Un mes despu & eacute;s del alta, el 29,2% de los pacientes presentaba s & iacute;ntomas de depresi & oacute;n y el 36% presentaban s & iacute;ntomas de TEPT; al cabo de un a & ntilde;o, las cifras respectivas eran del 32,4% y el 31%. La coexistencia de s & iacute;ntomas de depresi & oacute;n y TEPT represent & oacute; aproximadamente la mitad de todos los casos sintom & aacute;ticos. Los s & iacute;ntomas de TEPT aislados fueron m & aacute;s frecuentes en pacientes con VMI (p <= 0,014). La necesidad de VMI se asoci & oacute; con la aparici & oacute;n al mes (OR = 6,098, p = 0,005) y la persistencia a los 12 meses (OR = 3,271, p = 0,030) de s & iacute;ntomas de cualquiera de estos dos trastornos mentales.Conclusiones: Los s & iacute;ntomas com & oacute;rbidos de depresi & oacute;n y TEPT fueron muy frecuentes en nuestra muestra de supervivientes de enfermedad cr & iacute;tica por COVID-19. La necesidad de VMI predijo la aparici & oacute;n a corto plazo y la persistencia a largo plazo de s & iacute;ntomas de estos dos trastornos mentales, especialmente de s & iacute;ntomas de TEPT. El papel espec & iacute;fico de la disnea en la asociaci & oacute;n entre la VMI y los trastornos mentales tras la UCI merece mayor investigaci & oacute;n.