Family Visitation During ICU Stays May Reduce Post-Discharge Psychiatric Risk

Study data published in Chest emphasize the long-term risk for psychiatric disorders in patients admitted to the intensive care unit (ICU). In this cohort study of patients with an ICU stay, over a third were diagnosed with a psychiatric disorder in the year after discharge. Family visitation in the ICU was associated with a lower risk for incident psychiatric disorders following discharge.  

Survivors of critical illness are at greater risk for psychiatric disorders. Current clinical guidelines advocate for family visitation in the ICU, which can provide emotional support and assistance in decision making. However, the precise impact of family visitation on post-ICU psychiatric risk remains unclear.

To inform this gap, investigators conducted a retrospective study of adult patients admitted to the ICU at 14 participating hospitals in Alberta, Canada between January 1, 2014 and May 30, 2017. Eligible patients had a stay of ≥3 days and survived to hospital discharge.

Baseline demographic and clinical data were extracted from electronic medical records. The primary exposure was family visitation, described as 1 or more physical visits from a person important to the patient. The primary outcome was incident psychiatric disorder in the 1 year following discharge. Propensity scores were used in inverse probability weighted logistic regression models to estimate the risk ratios (RRs) of psychiatric disorders after ICU discharge.

The study cohort comprised 14,344 patients, among whom 13,771 (96%) had family visitation during their ICU stay. Median (interquartile range [IQR]) age was 59 (46-69) years; median ICU stay length was 6.2 (4.2-10.3) days. Median (IQR) stay length was greater for patients who were visited during their stay compared with patients who were not visited (6.3 [4.3-10.6] vs 4.3 [3.7-6.2] days; P <.01). Patients who were not visited were more likely to be men (68.8% vs 58.0%; P <.01).

Over a third of patients were diagnosed with a psychiatric disorder in the first year postdischarge (34.9%; 95% confidence interval [CI], 34.1-35.6%). The most common diagnoses were incident anxiety disorders (17.5%; 95% CI, 16.9-18.1%) and incident depressive disorders (17.2%; 95% CI, 16.6-17.9%).

In unadjusted models, family visitation was not associated with a reduced risk for psychiatric disorders. However, after propensity score matching, the 1-year risk for any incident psychiatric disorder was lower in the visited group compared with the non-visited group (RR, 0.79; 95% CI, 0.68-0.92). Visitation was not associated with any specific psychiatric diagnosis, but instead lowered the overall risk for any disorder.

Results from this analysis found that critically ill patients substantial high risk for psychiatric disorders in the year following ICU discharge. In-person family visits in the ICU were associated with reduced risk for a psychiatric diagnosis after discharge. Study limitations include the small number of patients without visitation, which prevented further stratified analysis.

“Critically ill patients with in-person family visitation had decreased risk for psychiatric disorders up to 1-year after hospital discharge,” investigators wrote. “Given the high incidence, all patients, family members, and primary care physicians should be made aware of the risk and those without visitation should perhaps be identified as being at higher risk.”

Reference

Moss SJ, Rosgen BK, Lucini F, et al. Psychiatric outcomes in intensive care unit patients with family visitation: a population-based retrospective cohort study. Chest. Published online March 7, 2022. doi:10.1016/j.chest.2022.02.051