An ICU admission is associated with a higher rate of suicide and self-harm after discharge when compared to hospital admissions without an ICU stay, according to the first study of its kind published in the medical journal The BMJ.
“ICU care has advanced in the last decades, and 70 to 80 percent of patients now survive,” said Dr. Shannon Fernando, a critical care fellow at the University of Ottawa and The Ottawa Hospital. “Unfortunately, we know this experience can be traumatic for patients, and will define someone’s health for a long time. These patients are often in hospital for weeks or months and need intense rehabilitation to get their strength back. 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.”
A team of researchers from the University of Ottawa, The Ottawa Hospital, the Institut du Savoir Montfort, and ICES looked at health records from all ICU survivors in Ontario, Canada from 2009 to 2017. They matched the ICU survivors with hospitalized patients who had similar risk factors for suicide including age, sex, mental health history, and previous hospitalization for self-harm.
Of the 423,000 ICU survivors in the study, 750 (0.2%) died by suicide, compared with 2,427 (0.1%) of the 3 million non-ICU hospital survivors. Self- harm was seen in 5,662 (1.3%) of the ICU survivors compared to 24,411 (0.8%) of the non-ICU hospital survivors. It’s not known how these rates compare to suicide and self-harm rates among the general population in Ontario, as reliable statistics do not exist.
Among the ICU survivors, the highest rates of suicide were seen in younger patients (ages 18-34), those with pre-existing diagnoses of depression, anxiety or PTSD, and those who received invasive procedures such as mechanical ventilation or mechanical blood filtration due to kidney failure in the ICU. Identifying these patients can impact their care, and potentially influence their outcomes after they leave hospital.
“This study can help us evaluate screening criteria for at-risk patients. Suicide is often preventable, and there are things we can do at all levels at healthcare to help.” said Dr. Kwadwo Kyeremanteng, co-senior author on the paper and assistant professor at the University of Ottawa, scientist and critical care physician at The Ottawa Hospital, and senior clinician investigator at the Institut du-savoir Montfort.
The team is conducting further research to better understand the healthcare experience of these higher-risk ICU patients after they leave hospital, including how soon they receive outpatient mental health care and whether they are re-hospitalized.
This study’s findings are particularly relevant during the COVID-19 pandemic, as ICU admissions reach all-time highs in Canada and around the world. In Ontario, ICUs are now seeing greater numbers of younger COVID-19 patients who need mechanical ventilation, populations which this study shows are at higher risk of future suicide and self-harm.
“Because of COVID-19, we’re seeing 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 Dr. Peter Tanuseputro, co-senior author, assistant professor at the University of Ottawa, physician-scientist at The Ottawa Hospital and ICES, and investigator at the Bruyère Research Institute.
“Patients and their loved ones shouldn’t be afraid if they need life-saving care in the ICU, as the rates of suicide we found are still very low,” said Dr. Fernando. “Our main message to patients is that it’s okay to not be okay after an ICU admission, and as physicians we’re becoming more aware of this.”
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