title: Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation.
abstract: BACKGROUND
  Psychiatric morbidity after acute respiratory distress syndrome (ARDS) is common, and our current ability to predict psychiatric symptoms based on patient- and illness-specific factors is limited.
  
  
  OBJECTIVE
  We assessed symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) in long-term survivors of ARDS, as well as the associated changes in cortisol levels.
  
  
  METHODS
  The participants were enrolled in a randomized, double-blind, placebo-controlled trial of granulocyte macrophage-colony stimulating factor (GM-CSF) or placebo conducted at three academic medical centers. There were 132 patients enrolled, and 44 patients completed 6-month follow-up questionnaires (45% of survivors).
  
  
  RESULTS
  Six months after enrollment, survivors completed the Post-Traumatic Stress Syndrome 10 Questions Inventory, Impact of Event Scale, and Hospital Anxiety and Depression Scale to assess psychiatric symptoms. Plasma cortisol levels during treatment were measured by immunoassay. Thirty-six percent of patients reported significant psychiatric symptoms on at least one scale. GM-CSF-treated patients reported more severe posttraumatic stress and depression symptoms than patients in the placebo group. In multiple regression analyses, younger age, female sex, higher severity of illness, fewer steroid treatment days, and GM-CSF treatment were all independently associated with more severe psychiatric symptoms on at least one scale.
  
  
  CONCLUSIONS
  6 months after ARDS, age, sex, illness severity, steroids, and GM-CSF treatment were associated with psychiatric symptom scores. These associations should be confirmed in a larger population. Clinical Trial registered with clinicaltrials.gov (NCT00201409).
authors.affiliation: 1 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes.|2 Molecular and Behavioral Neuroscience Institute, and.
authors.forename: Joanna L
authors.identifier: http://orcid.org/0000-0003-0467-2173
authors.initials: JL
authors.lastname: Spencer-Segal
authors.affiliation: 3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Robert C
authors.identifier: http://orcid.org/0000-0003-1890-4932
authors.initials: RC
authors.lastname: Hyzy
authors.affiliation: 3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan; and.|4 Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan.
authors.forename: Theodore J
authors.identifier: http://orcid.org/0000-0002-4226-9310
authors.initials: TJ
authors.lastname: Iwashyna
authors.affiliation: 3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Theodore J
authors.identifier: http://orcid.org/0000-0002-5890-4470
authors.initials: TJ
authors.lastname: Standiford
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000523:psychology*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014481:United States
chemical_list: D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D006854:Hydrocortisone
keywords: GM-CSF; acute respiratory distress syndrome; cortisol; depression; posttraumatic stress disorder