title: The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: Results from the BRAIN-ICU investigation.
abstract: Although executive dysfunction and depression are common among intensive care unit (ICU) survivors, their relationship has not been evaluated in this population. We sought to determine (1) if executive dysfunction is independently associated with severity of depressive symptoms or worse mental health-related quality of life (HRQOL) in ICU survivors, and (2) if age modifies these associations.
  
  
  
  In a prospective cohort (n=136), we measured executive dysfunction by the Behavior Rating Inventory of Executive Function-Adult, depression by the Beck Depression Inventory-II, and mental HRQOL by the Short-Form 36. We used multiple linear regression models, adjusting for potential confounders. We included age as an interaction term to test for effect modification.
  
  
  
  Executive dysfunction 3 months post-ICU was independently associated with more depressive symptoms and worse mental HRQOL 12 months post-ICU (25th vs 75th percentile of executive functioning scored 4.3 points worse on the depression scale [95% confidence interval, 1.3-7.4; P=.015] and 5 points worse on the Short-Form 36 [95% confidence interval, 1.7-8.3; P=.006]). Age did not modify these associations (depression: P=.12; mental HRQOL: P=.80).
  
  
  
  Regardless of age, executive dysfunction was independently associated with subsequent worse severity of depressive symptoms and worse mental HRQOL. Executive dysfunction may have a key role in the development of depression.
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN; Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Division of Geriatric Medicine, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: maria.e.carlo@vanderbilt.edu.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Duggan
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN; Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Jo Ellen
authors.initials: JE
authors.lastname: Wilson
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN; Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN; Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Research Service, Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN.
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
mesh_terms: D000367:Age Factors; D000368:Aged; D001921:Brain; D060825:Cognitive Dysfunction / Q000523:psychology*; D015331:Cohort Studies; D016638:Critical Illness / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D013997:Time Factors
keywords: Cognitive impairment; Critical illness; Depression; Executive dysfunction; Quality of life