Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: PHQ-2 ≥3 associated with -0.13 reduction in EQ-5D-5L index and -12.45 point reduction in EQ VAS

• Primary Outcome: Health-related quality of life (EQ-5D-5L index and VAS)

• Nnt Or Sensitivity: Depression screening exceeded clinical and demographic predictors in importance

• Confidence Interval: EQ-5D-5L: 95% CI -0.19 to -0.07; EQ VAS: 95% CI -17.93 to -6.96

Clinical Application

PHQ-2 is brief, validated, and easily implemented in post-ICU follow-up clinics Relevant to Australian ICU follow-up services; PHQ-2 screening aligns with RACGP depression screening guidelines and could inform Medicare-funded mental health care plans ICU survivors in Australian hospitals, particularly those with psychological distress symptoms

Abstract

Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care-based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up.Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).

References

1. 1.Kosilek, R. P., Schröder, N., Sanftenberg, L., Lindemann, D., Beutel, A., Schmidt, K., Brettschneider, C., König, H. H., & Gensichen, J. (2026). Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress. Scientific Reports. https://doi.org/10.1002/sim.4067