Survivors of the intensive care unit (ICU) have a higher risk of self-harm and suicide after discharge than other hospital patients, a Canadian study shows.

Researchers compared the health records of 423,000 ICU survivors in the province of Ontario with those of with 3 million patients who were hospitalized but not in intensive care between 2009 and 2017.

Compared to others, ICU survivors had a 22% higher risk of suicide and a 15% higher risk of self-harm, according to findings published May 5 in the BMJ. A team from The Ottawa Hospital and University of Ottawa did the study.

“ICU care has advanced in the last decades, and 70% to 80% of patients now survive,” said lead author Dr. Shannon Fernando, a critical care fellow. “Unfortunately, we know this experience can be traumatic for patients, and will define someone’s health for a long time.”

Of the ICU survivors, 0.2% (750) died by suicide, compared with 0.1% (2,427) of other hospital survivors, the study found. Rates of self-harm were 1.3% among ICU survivors and 0.8% among others.

The highest suicide rates among ICU survivors were found in 18- to 34-year-olds, patients with previous diagnoses of depression, anxiety or post-traumatic stress disorder; and those who received invasive procedures in the ICU such as mechanical ventilation or blood filtration due to kidney failure.

“These patients are often in hospital for weeks or months and need intense rehabilitation to get their strength back,” Fernando said in a hospital news release. “Once they return home, they may not be able to work full time or at all. We know all of this impacts their mental health. While intuitively all these factors could lead to increased risks of self-harm and suicide, we didn’t have clear data until now.”

Study co-author Dr. Kwadwo Kyeremanteng, who is also a critical care doctor, said the findings can help doctors evaluate screening criteria for at-risk patients.

“Suicide is often preventable, and there are things we can do at all levels at health care to help,” he said.

Researchers said their findings are especially significant during the COVID-19 pandemic, which has brought an unprecedented number of ICU admissions worldwide.

“This is a timely study that shows care should not end when patients leave the hospital, and should address both physical and mental health needs,” said co-author Dr. Peter Tanuseputro, physician-scientist at The Ottawa Hospital Research Institute.

However, the study only found a correlation between ICU time and risk of suicide, not a cause-and-effect link.

Researcher Fernando said patients and their families shouldn’t be afraid if they need lifesaving care in the ICU as suicide rates found in the study are still very low.

“Our main message to patients is that it’s OK to not be OK after an ICU admission, and as physicians we’re becoming more aware of this,” he said.

More information

The U.S. National Institute of Mental Health has more on suicide prevention.

SOURCE: Ottawa Hospital, news release, May 5, 2021

Source: HealthDay