Association Between Preexisting Mental Health Disorders and Adverse Outcomes in Adult Intensive Care Patients: A Data Linkage Study.

Pilowsky, JK; Elliott, R; Roche, MA

Association Between Preexisting Mental Health Disorders and Adverse Outcomes in Adult Intensive Care Patients: A Data Linkage Study.

Pilowsky, JK Elliott, R

Roche, MA

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Publisher:: Wolters Kluwer
Publication Type:: Journal Article
Citation:: Crit Care Med, 2023, 51, (4), pp. 513-524
Issue Date:: 2023-04-01

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Field	Value	Language
dc.contributor.author	Pilowsky, JK
dc.contributor.author	Elliott, R https://orcid.org/0000-0002-9239-7126
dc.contributor.author	Roche, MA
dc.date.accessioned	2023-09-13T06:36:57Z
dc.date.available	2023-09-13T06:36:57Z
dc.date.issued	2023-04-01
dc.identifier.citation	Crit Care Med, 2023, 51, (4), pp. 513-524
dc.identifier.issn	0090-3493
dc.identifier.issn	1530-0293
dc.identifier.uri	http://hdl.handle.net/10453/172081
dc.description.abstract	OBJECTIVES: Mental illness is known to adversely affect the physical health of patients in primary and acute care settings; however, its impact on critically ill patients is less well studied. This study aimed to determine the prevalence, characteristics, and outcomes of patients admitted to the ICU with a preexisting mental health disorder. DESIGN: A multicenter, retrospective cohort study using linked data from electronic ICU clinical progress notes and the Australia and New Zealand Intensive Care Society Adult Patient Database. SETTING/PATIENTS: All patients admitted to eight Australian adult ICUs in the calendar year 2019. Readmissions within the same hospitalization were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Natural language processing techniques were used to classify preexisting mental health disorders in participants based on clinician documentation in electronic ICU clinical progress notes. Sixteen thousand two hundred twenty-eight patients (58% male) were included in the study, of which 5,044 (31.1%) had a documented preexisting mental health disorder. Affective disorders were the most common subtype occurring in 2,633 patients (16.2%), followed by anxiety disorders, occurring in 1,611 patients (9.9%). Mixed-effects regression modeling found patients with a preexisting mental health disorder stayed in ICU 13% longer than other patients (β-coefficient, 0.12; 95% CI, 0.10-0.15) and were more likely to experience invasive ventilation (odds ratio, 1.42; 95% CI, 1.30-1.56). Severity of illness and ICU mortality rates were similar in both groups. CONCLUSIONS: Patients with preexisting mental health disorders form a significant subgroup within the ICU. The presence of a preexisting mental health disorder is associated with greater ICU length of stay and higher rates of invasive ventilation, suggesting these patients may have a different clinical trajectory to patients with no mental health history. Further research is needed to better understand the reasons for these adverse outcomes and to develop interventions to better support these patients during and after ICU admission.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wolters Kluwer
dc.relation.ispartof	Crit Care Med
dc.relation.isbasedon	10.1097/CCM.0000000000005792
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1110 Nursing, 1117 Public Health and Health Services
dc.subject.classification	Emergency & Critical Care Medicine
dc.subject.classification	3202 Clinical sciences
dc.subject.classification	4205 Nursing
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Adult
dc.subject.mesh	Female
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Australia
dc.subject.mesh	Critical Care
dc.subject.mesh	Intensive Care Units
dc.subject.mesh	Mental Disorders
dc.subject.mesh	Information Storage and Retrieval
dc.subject.mesh	Critical Illness
dc.subject.mesh	Humans
dc.subject.mesh	Critical Illness
dc.subject.mesh	Critical Care
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Mental Disorders
dc.subject.mesh	Information Storage and Retrieval
dc.subject.mesh	Adult
dc.subject.mesh	Intensive Care Units
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Adult
dc.subject.mesh	Female
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Australia
dc.subject.mesh	Critical Care
dc.subject.mesh	Intensive Care Units
dc.subject.mesh	Mental Disorders
dc.subject.mesh	Information Storage and Retrieval
dc.subject.mesh	Critical Illness
dc.title	Association Between Preexisting Mental Health Disorders and Adverse Outcomes in Adult Intensive Care Patients: A Data Linkage Study.
dc.type	Journal Article
utslib.citation.volume	51
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access	*
dc.date.updated	2023-09-13T06:36:56Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	51
utslib.citation.issue	4

Abstract:

OBJECTIVES: Mental illness is known to adversely affect the physical health of patients in primary and acute care settings; however, its impact on critically ill patients is less well studied. This study aimed to determine the prevalence, characteristics, and outcomes of patients admitted to the ICU with a preexisting mental health disorder. DESIGN: A multicenter, retrospective cohort study using linked data from electronic ICU clinical progress notes and the Australia and New Zealand Intensive Care Society Adult Patient Database. SETTING/PATIENTS: All patients admitted to eight Australian adult ICUs in the calendar year 2019. Readmissions within the same hospitalization were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Natural language processing techniques were used to classify preexisting mental health disorders in participants based on clinician documentation in electronic ICU clinical progress notes. Sixteen thousand two hundred twenty-eight patients (58% male) were included in the study, of which 5,044 (31.1%) had a documented preexisting mental health disorder. Affective disorders were the most common subtype occurring in 2,633 patients (16.2%), followed by anxiety disorders, occurring in 1,611 patients (9.9%). Mixed-effects regression modeling found patients with a preexisting mental health disorder stayed in ICU 13% longer than other patients (β-coefficient, 0.12; 95% CI, 0.10-0.15) and were more likely to experience invasive ventilation (odds ratio, 1.42; 95% CI, 1.30-1.56). Severity of illness and ICU mortality rates were similar in both groups. CONCLUSIONS: Patients with preexisting mental health disorders form a significant subgroup within the ICU. The presence of a preexisting mental health disorder is associated with greater ICU length of stay and higher rates of invasive ventilation, suggesting these patients may have a different clinical trajectory to patients with no mental health history. Further research is needed to better understand the reasons for these adverse outcomes and to develop interventions to better support these patients during and after ICU admission.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/172081