title: Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To synthesize data on prevalence, natural history, risk factors, and post-ICU interventions for depressive symptoms in ICU survivors.
  
  
  METHODS
  PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry (1970-2015).
  
  
  METHODS
  Studies measuring depression after hospital discharge using a validated instrument in more than 20 adults from non-specialty ICUs.
  
  
  METHODS
  Duplicate independent review and data abstraction.
  
  
  RESULTS
  The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n = 4,113). The Hospital Anxiety and Depression Scale-Depression subscale was used most commonly (58%). The pooled Hospital Anxiety and Depression Scale-Depression subscale prevalence (95% CI) of depressive symptoms at a threshold score greater than or equal to 8 was 29% (22-36%) at 2-3 months (12 studies; n = 1,078), 34% (24-43%) at 6 months (seven studies; n = 760), and 29% (23-34%) at 12-14 months (six studies; n = 1,041). The prevalence of suprathreshold depressive symptoms (compatible with Hospital Anxiety and Depression Scale-Depression subscale, ≥ 8) across all studies, using all instruments, was between 29% and 30% at all three time points. The pooled change in prevalence (95% CI) from 2-3 to 6 months (four studies; n = 387) was 5% (-1% to +12%), and from 6 to 12 months (three studies; n = 412) was 1% (-6% to +7%). Risk factors included pre-ICU psychologic morbidity and presence of in-ICU psychologic distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms.
  
  
  CONCLUSIONS
  Clinically important depressive symptoms occurred in approximately one-third of ICU survivors and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.
authors.affiliation: 1Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.2Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.3Department of Psychiatry and Behavior Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD.4Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.5Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Anahita
authors.initials: A
authors.lastname: Rabiee
authors.forename: Sina
authors.initials: S
authors.lastname: Nikayin
authors.forename: Mohamed D
authors.initials: MD
authors.lastname: Hashem
authors.forename: Minxuan
authors.initials: M
authors.lastname: Huang
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.forename: Alison E
authors.initials: AE
authors.lastname: Turnbull
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D003422:Critical Care; D016638:Critical Illness / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors