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Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation.
Ann Am Thorac Soc. 2017 Jun; 14(6):960-967.AA

Abstract

RATIONALE

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.

OBJECTIVES

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+Show Affiliations

1 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes. 2 Molecular and Behavioral Neuroscience Institute, and.3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan; and.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.3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan; and.

Pub Type(s)

Clinical Trial, Phase II
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28358594

Citation

Spencer-Segal, Joanna L., et al. "Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation." Annals of the American Thoracic Society, vol. 14, no. 6, 2017, pp. 960-967.
Spencer-Segal JL, Hyzy RC, Iwashyna TJ, et al. Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation. Ann Am Thorac Soc. 2017;14(6):960-967.
Spencer-Segal, J. L., Hyzy, R. C., Iwashyna, T. J., & Standiford, T. J. (2017). Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation. Annals of the American Thoracic Society, 14(6), 960-967. https://doi.org/10.1513/AnnalsATS.201606-468OC
Spencer-Segal JL, et al. Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation. Ann Am Thorac Soc. 2017;14(6):960-967. PubMed PMID: 28358594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation. AU - Spencer-Segal,Joanna L, AU - Hyzy,Robert C, AU - Iwashyna,Theodore J, AU - Standiford,Theodore J, PY - 2017/3/31/pubmed PY - 2018/4/20/medline PY - 2017/3/31/entrez KW - GM-CSF KW - acute respiratory distress syndrome KW - cortisol KW - depression KW - posttraumatic stress disorder SP - 960 EP - 967 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 14 IS - 6 N2 - RATIONALE: 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. OBJECTIVES: 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). SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/28358594/Psychiatric_Symptoms_in_Survivors_of_Acute_Respiratory_Distress_Syndrome__Effects_of_Age_Sex_and_Immune_Modulation_ L2 - https://www.atsjournals.org/doi/10.1513/AnnalsATS.201606-468OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -