title: Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study.
abstract: BACKGROUND
  Survivors of acute lung injury (ALI) frequently have substantial depressive symptoms and physical impairment, but the longitudinal epidemiology of these conditions remains unclear.
  
  
  OBJECTIVE
  To evaluate the 2-year incidence and duration of depressive symptoms and physical impairment after ALI, as well as risk factors for these conditions.
  
  
  METHODS
  This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12, and 24 months after ALI. The outcomes were Hospital Anxiety and Depression Scale depression score greater than or equal to 8 ("depressive symptoms") in patients without a history of depression before ALI, and two or more dependencies in instrumental activities of daily living ("impaired physical function") in patients without baseline impairment.
  
  
  RESULTS
  During 2-year follow-up of 186 ALI survivors, the cumulative incidences of depressive symptoms and impaired physical function were 40 and 66%, respectively, with greatest incidence by 3-month follow-up; modal durations were greater than 21 months for each outcome. Risk factors for incident depressive symptoms were education 12 years or less, baseline disability or unemployment, higher baseline medical comorbidity, and lower blood glucose in the ICU. Risk factors for incident impaired physical function were longer ICU stay and prior depressive symptoms.
  
  
  CONCLUSIONS
  Incident depressive symptoms and impaired physical function are common and long-lasting during the first 2 years after ALI. Interventions targeting potentially modifiable risk factors (e.g., substantial depressive symptoms in early recovery) should be evaluated to improve ALI survivors' long-term outcomes.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jbienven@jhmi.edu
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Bienvenu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Nadia
authors.initials: N
authors.lastname: Husain
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Dennison
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D055371:Acute Lung Injury / Q000150:complications* / Q000523:psychology; D001786:Blood Glucose / Q000032:analysis; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D014478:Unemployment / Q000523:psychology
chemical_list: D001786:Blood Glucose