title: Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*.
abstract: OBJECTIVE
  To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder symptoms at 3 months post-ICU, are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours.
  
  
  METHODS
  None.
  
  
  RESULTS
  Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the Posttraumatic Stress Disorder Checklist-Civilian version. Substantial depressive and posttraumatic stress disorder symptoms were assessed using the Patient Health Questionnaire-9 and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively, at 3 months post-ICU. The number of rehospitalizations and emergency department visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (relative risk, 3.00; 95% CI, 1.80-4.99) over the year post-ICU. Substantial posttraumatic stress disorder symptoms at 3 months post-ICU were independently associated with greater risk of an additional emergency department visit during the subsequent 9 months (relative risk, 2.29; 95% CI, 1.09-4.84) even after adjusting for both rehospitalizations and emergency department visits between the index hospitalization and 3 months post-ICU.
  
  
  CONCLUSIONS
  Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve long-term outcomes and reduce subsequent acute care utilization.
authors.affiliation: 1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. 2Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Dimitry S
authors.initials: DS
authors.lastname: Davydow
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
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