Hospital anxiety depression scale in our surgical ICU

Introduction

All patients in the ICU go through mental, physical and emotional adjustment. They can experience exaggerated symptoms of anxiety and depression and it can delay their recovery [1]. Stress has a major role and there are so many triggers for it: the psychological and physical condition, surgery, pain, ICU environment and so forth. The aim of this study was to implement the Hospital Anxiety Depression Scale (HADS) in our everyday ICU practice and then to analyze the impact of the clinical picture (APACHE II score) and pain control (VAPS - visual analog pain scale) on the anxiety and depression symptoms (HADS) in surgical ICU patients.

Methods

With ethics approval and written consent, in this prospective study, to date are reported 70 patients. They all underwent major abdominal surgery and were discharged from the ICU after 24 to 30 hours. Patients with any mental disorder or neurological disease were excluded. On admission and discharge the VAPS, APACHE II and HADS were evaluated. HADS was evaluated again 1 month later (62 of 70 patients). Anxiety and depression are assessed as separate components, each with seven items that are rated from 0 to 3 [2]. A score <7 in a component is a normal result, 8 to 10 indicates mild symptoms, 11 to 14 moderate symptoms and 15 or more indicates severe symptoms [2]. The Mann-Whitney U test, t test and correlations were used in statistical analysis.

Results

Average age of the patients was 58.61 ± 13.56, range 24 to 78, 37 male and 33 female. Average values on admission were: VAPS 3.02 ± 0.50, APACHE II 10.31 ± 2.79, Anxiety 4.82 ± 4.01, Depression 3.91 ± 3.23, and on discharge were: VAPS 1.34 ± 0.88, APACHE II 5.25 ± 2.78, Anxiety 3.41 ± 2.97, Depression 3.71 ± 2.97. One month later the values were: Anxiety 3.14 ± 2.79, Depression 1.27 ± 0.57.

Patients with lower pain control had more exaggerated symptoms of anxiety and depression. After 1 month, seven patients had mild symptoms of anxiety, nine patients had mild symptoms of depression and four patients had moderate symptoms of depression.

Conclusions

HADS has its role in everyday ICU practice. All patients with mild to severe symptoms of anxiety or depression should be further psychologically evaluated. There is a need to evaluate in our ICU the patients who are staying there a few days or more and compare it with the results of this study.