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<p>Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care–based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up.</p><p>Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).</p>

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Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress

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  • 发表日期：

    2026年5月25日

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  • Robert Philipp Kosilek,
  • Nora Schröder,
  • Linda Sanftenberg,
  • Daniela Lindemann,
  • Antina Beutel,
  • Konrad Schmidt,
  • Christian Brettschneider,
  • Hans-Helmut König,
  • Jochen Gensichen,
  • Christine Adrion,
  • Matthias Angstwurm,
  • Antje Bergmann,
  • Gerhard Bielmeier,
  • Andrea Bischhoff,
  • Ralph Bogdanski,
  • Katja Brenk-Franz,
  • Franz Brettner,
  • Josef Briegel,
  • Martin Bürkle,
  • Johanna Dohmann,
  • Thomas Elbert,
  • Peter Falkai,
  • Thomas Felbinger,
  • Richard Fisch,
  • Hans Förstl,
  • Benjamin Fohr,
  • Martin Franz,
  • Patrick Friederich,
  • Chris-Maria Friemel,
  • Jürgen Gallinat,
  • Sabine Gehrke-Beck,
  • Herwig Gerlach,
  • Andreas Güldner,
  • Hanna Hardt,
  • Irene Heimbeck,
  • Christoph Heintze,
  • Andreas Heinz,
  • Axel Heller,
  • Simona Hennig,
  • Christian von Heymann,
  • Petra Hoppmann,
  • Volker Huge,
  • Michael Irlbeck,
  • Ulrich Jaschinski,
  • Dominik Jarczak,
  • Stefanie Joos,
  • Caroline Jung-Sievers,
  • Elisabeth Kaiser,
  • Melanie Kerinn,
  • Frank-Rainer Klefisch,
  • Stefan Kluge,
  • Roland Koch,
  • Thea Koch,
  • Michelle Kowalski,
  • Peter Lackermeier,
  • Karl-Ludwig Laugwitz,
  • Tri Le,
  • Yvonne Lemke,
  • Achim Lies,
  • Klaus Linde,
  • Dagmar Lühmann,
  • Stephanie May,
  • Ludwig Ney,
  • Jan Oltrogge,
  • Wulf Pankow,
  • Sergi Papiol,
  • Maximilian Ragaller,
  • Nikolaus Rank,
  • Jonas Raub,
  • Lorenz Reill,
  • Ulf-Dietrich Reips,
  • Siegfried Reitberger,
  • Hans-Peter Richter,
  • Reimer Riessen,
  • Grit Ringeis,
  • Ann Rüchardt,
  • Maggie Schauer,
  • Gustav Schelling,
  • Jörg Schelling,
  • André Scherag,
  • Martin Scherer,
  • Antonius Schneider,
  • Gerhard Schneider,
  • Jürgen Schneider,
  • Sophie Schneider,
  • Julia Schnurr,
  • Tomke Schubert,
  • Susanne Schultz,
  • Thomas G. Schulze,
  • Karin Schumacher,
  • John Singhammer,
  • Peter Spieth,
  • Kerstin Theisen,
  • Franka Thurm,
  • Natalia Unruh,
  • Thomas Vogl,
  • Karen Voigt,
  • Cornelia Wäscher,
  • Andreas Walther,
  • Dietmar Wassilowsky,
  • Regina Wehrstedt,
  • Roland Weierstall-Pust,
  • Marion Weis,
  • Björn Weiss,
  • Georg Weiss,
  • Harald Well,
  • Christian Zöllner,
  • Bernhard Zwissler

摘要

Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care–based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up.

Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).