title: Cooccurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study.
abstract: OBJECTIVE
  To evaluate the cooccurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder symptoms during 2-year follow-up in survivors of acute lung injury treated in an ICU.
  
  
  METHODS
  Prospective cohort study, with follow-up at 3, 6, 12, and 24 months post-acute lung injury.
  
  
  METHODS
  Thirteen medical and surgical ICUs in four hospitals.
  
  
  METHODS
  Survivors among 520 patients with acute lung injury.
  
  
  RESULTS
  The outcomes of interest were measured using the Hospital Anxiety and Depression Scale anxiety and depression subscales (scores ≥ 8 indicating substantial symptoms) and the Impact of Event Scale-Revised (scores ≥ 1.6 indicating substantial posttraumatic stress disorder symptoms). Of the 520 enrolled patients, 274 died before 3-month follow-up; 186 of 196 consenting survivors (95%) completed at least one Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised assessment during 2-year follow-up, and most completed multiple assessments. Across follow-up time points, the prevalence of suprathreshold general anxiety, depression, and posttraumatic stress disorder symptoms ranged from 38% to 44%, 26% to 33%, and 22% to 24%, respectively; more than half of the patients had suprathreshold symptoms in at least one domain during 2-year follow-up. The majority of survivors (59%) with any suprathreshold symptoms were above threshold for two or more types of symptoms (i.e., general anxiety, depression, and/or posttraumatic stress disorder). In fact, the most common pattern involved simultaneous general anxiety, depression, and posttraumatic stress disorder symptoms. Most patients with general anxiety, depression, or posttraumatic stress disorder symptoms during 2-year follow-up had suprathreshold symptoms at 24-month (last) follow-up. Higher Short-Form-36 physical functioning domain scores at the prior visit were associated with a greater likelihood of remission from general anxiety and posttraumatic stress disorder symptoms during follow-up.
  
  
  CONCLUSIONS
  The majority of acute lung injury survivors had clinically significant general anxiety, depression, or posttraumatic stress disorder symptoms, and these symptoms tended to co-occur across domains. Better physical functioning during recovery predicted subsequent remission of general anxiety and posttraumatic stress disorder symptoms.
authors.affiliation: 1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. 2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 5Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 6Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 7Johns Hopkins University School of Nursing, Baltimore, MD. 8Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 9Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 10Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: O Joseph
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: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Dennison-Himmelfarb
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000523:psychology*; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D016638:Critical Illness / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D015438:Health Behavior; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012075:Remission, Spontaneous; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D017741:Survivors