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Admission to an intensive care unit (ICU) is associated with a slightly increased risk of future suicide or self-harm after discharge compared to hospitalization outside the intensive care unit. This is the result of a study published today in the BMJ.
The results are particularly relevant during the COVID-19 pandemic as the number of intensive care admissions reaches an all-time high worldwide.
The results show that critical disease survivors who later died from suicide or had self-harming events with a history of psychiatric illness tended to be younger and received invasive life support.
The researchers stress that the overall risk is still very small, but say that knowing these factors "could allow earlier intervention to potentially reduce this important public health problem".
Survival from critical illness is associated with important effects, including muscle weakness, decreased exercise capacity, fatigue, cognitive impairment, pain, and financial difficulty. Growing evidence shows that ICU survivors are more likely to suffer from psychiatric illnesses. However, it is not known whether this leads to an increased risk of suicide and self-harm.
To investigate this further, researchers in Canada and the United States looked at the association between survival after critical illness and suicide or self-harm after discharge from the hospital.
Their findings are based on health records of 423,000 adult survivors in the intensive care unit (mean age 62 years, 39% women) in Ontario, Canada, from 2009 to 2017.
They compared the health data of 423,000 adult survivors in the ICU (mean age 62 years, 39% women) with 3 million survivors outside the ICU with similar risk factors for suicide in Ontario, Canada, from 2009 to 2017.
Potentially influential factors such as age, gender, mental health, and previous hospitalizations for self-harm were considered.
The researchers found that among ICU survivors, 750 patients (0.2%) died of suicide (41 per 100,000 person-years during the study period) compared with 2,427 (0.1%) survivors outside the ICU (17 per 100,000 Person-years during the study period)).
Self-harm was observed in 5,662 (1.3%) ICU survivors (328 per 100,000 person-years during the study period) compared to 24,411 (0.8%) ICU survivors (177 per 100,000 person-years during the study period).
Overall, the analysis found that survivors in the ICU had a 22% higher risk of suicide than survivors in hospitals outside the ICU and a 15% higher risk of self-harm. This increased risk was apparent almost immediately after hospital discharge and persisted for years afterwards.
Among ICU survivors, the highest rates of suicide were seen in younger patients (aged 18 to 34 years), in those with pre-existing diagnoses of depression, anxiety, or PTSD, and in those undergoing invasive procedures such as mechanical ventilation or mechanical blood filtration related to kidney failure in the intensive care unit.
This is a large study involving a cohort of consecutive ICU survivors from an entire population with minimal missing data. However, given the design of the observations, the researchers cannot rule out that other unmeasured factors may have influenced their results and say these associations require further investigation.
"Critical disease survivors are at increased risk of suicide and self-harm, and these outcomes have been linked to pre-existing psychiatric illness and the receipt of invasive life support," they write.
"Knowledge of these prognostic factors could enable earlier intervention to potentially reduce this important public health problem," they conclude.
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Suicide and Self-Harm in Adult Critical Disease Survivors: Population-Based Cohort Study BMJ (2021). www.bmj.com/content/373/bmj.n973
British Medical Journal
Intensive care admission linked to an increased risk of future suicide and self-harm (May 5, 2021)
accessed on May 6, 2021
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