Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome.

OBJECTIVE: Depression and anxiety are common morbidities of critical illness. We assessed risk factors of depression and anxiety in Acute Respiratory Distress Syndrome (ARDS) survivors at 1 and 2 years post-hospital discharge. METHOD: Risk factors for depression and anxiety at 1 and 2 years were assessed using stepwise multiple regression analyses, with and without 1-year outcomes. RESULTS: ARDS survivors had depression (16% and 23%) and anxiety (24% and 23%) at 1 and 2 years, respectively. Predictors of depression at 1 year were alcohol dependence, female gender and younger age (P=.006). Predictors of anxiety were ratio of arterial oxygen tension to inspired oxygen fraction and duration of mechanical ventilation (P<.005). Predictors of depression at 2 years were depression at 1 year and the presence of cognitive sequelae (P<.0001). Predictors of anxiety at 2 years was anxiety at 1 year (P<.0001). CONCLUSIONS: Medical variables that predicted depression or anxiety at 1 year no longer predicted depression and anxiety at 2 years. Medical variables appear to have a short-term effect on psychiatric outcomes. At 2 years lifestyle behaviors including history of smoking along with cognitive sequelae, depression and anxiety at 1 year predict depression and anxiety.

Substance dependence and psychiatric disorders are related to outcomes in a mixed ICU population.

OBJECTIVE: Substance dependence disorders are common in hospitalized patients and are associated with poor recovery. We compared mortality and discharge disposition in critically ill patients with and without substance dependence and patients with and without psychiatric disorders. We also compared the prevalence of substance dependence and psychiatric disorders to population data. METHODS: All medical records of shock trauma intensive care unit (ICU) patients (mixed medical and surgical) at LDS Hospital were reviewed for pre-critical illness alcohol dependence, drug dependence, and psychiatric disorders. RESULTS: There were 742 critically ill patients of whom 54% were male, acute respiratory distress syndrome developed in 5.5% and hospital mortality was 21%. The mean acute physiology and chronic health evaluation II scores were 16.5 +/- 7.9, sequential organ failure assessment scores were 6.7 +/- 4.2, duration of mechanical ventilation was 5 +/- 6.2 days, ICU length of stay (LOS) was 7.3 +/- 10.1 days, hospital LOS was 12.3 +/- 12.9 days. Multivariable regression analyses found psychiatric disorders predicted higher hospital mortality (Odds ratio = 1.50), but was not statistically significant (p = 0.08); substance dependence predicted shorter hospital LOS (R ( 2 ) = 0.08, p = 0.01) after controlling for covariates. There was a higher prevalence of substance dependence compared to Utah (p < 0.001) and US population data (p < 0.001). The prevalence of psychiatric disorders was significantly lower in our patients compared to US population data (19 vs. 26%, p < 0.001). CONCLUSIONS: Our data suggest that substance dependence increases hospital LOS and that patients with drug or alcohol dependence are at higher risk for ICU admission compared to the general population.

When god sanctions killing: effect of scriptural violence on aggression.

Violent people often claim that God sanctions their actions. In two studies, participants read a violent passage said to come from either the Bible or an ancient scroll. For half the participants, the passage said that God sanctioned the violence. Next, participants competed with an ostensible partner on a task in which the winner could blast the loser with loud noise through headphones (the aggression measure). Study 1 involved Brigham Young University students; 99% believed in God and in the Bible. Study 2 involved Vrije Universiteit-Amsterdam students; 50% believed in God, and 27% believed in the Bible. In Study 1, aggression increased when the passage was from the Bible or mentioned God. In Study 2, aggression increased when the passage mentioned God, especially among participants who believed in God and in the Bible. These results suggest that scriptural violence sanctioned by God can increase aggression, especially in believers.