Acute and Critical Care

Original Articles

Epidemiology
Post-traumatic stress disorder, anxiety, and depression in North African intensive care unit survivors: a prospective observational study: Imen Ben Saida, Marwa Zghidi, Safa Fathallah, Mohamed Boussarsar; Acute Crit Care. 2025;40(3):402-412. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.000150

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Background
Survivors of critical illness often face significant physical and psychological challenges, including post-traumatic stress disorder (PTSD), anxiety, and depression, which can severely impact their quality of life. This study aimed to evaluate the prevalence and associated factors of PTSD, anxiety, and depression among intensive care unit (ICU) survivors 3 months after discharge, and investigate the prevalence and determinants of post-intensive care syndrome–related neuropsychiatric disorders (PICS-ND).
Methods
This is a prospective observational analytical study carried out in a medical ICU. Three months after discharge from the ICU, survivors were contacted by telephone to complete the Impact Event Scale-Revised and Hospital Anxiety and Depression Scale questionnaires. Univariate and multivariate analyses were performed to identify variables that were independently and significantly associated with outcomes.
Results
A total of 114 survivors was enrolled. At 3 months, PTSD, anxiety, and depression were prevalent in 21.9%, 21.0%, and 9.6% of patients, respectively. Associated factors were younger age, female, physical restraint, and critical illness polyneuropathy and myopathy (CIPNM) for PTSD; unmarried, low Charlson index, and physical restraint for anxiety; and younger age and CIPNM for depression. PICS-ND, a composite measure of neuropsychiatric morbidity, was present in 28.9% of patients, with younger age, female, and physical restraint identified as associated factors.
Conclusions
PTSD, anxiety, depression, and PICS-ND were common among ICU survivors at 3 months. Various factors, including younger age, female, unmarried, lower Charlson index, physical restraint, and CIPNM, were associated with these psychological outcomes.

Citations

Citations to this article as recorded by

Effect of high-dose baclofen on post-traumatic stress disorder symptoms five years after hospitalization among critically ill patients with unhealthy alcohol use
Marwan Bouras, Karim Asehnoune, Yann Robert-Valli, Pierre-Joachim Mahe, Jean Reignier, Adel Maamar, Jean-Claude Lacherade, Maud Jonas, Boris Jung, Martine Ferrandiere, Samir Jaber, Laurent Flet, Mikael Moriconi, Sigismond Lasocki, Roland Smonig, Christoph
Scientific Reports.2026;[Epub] CrossRef

Nursing
Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit: Rui Domingues Silva, Abílio Cardoso Teixeira, José António Pinho, Pedro Marcos, José Carlos Santos; Acute Crit Care. 2024;39(2):312-320. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01256

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Abstract PDF

Background
Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables.
Methods
This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the “Richard Campbell Sleep Questionnaire” and “Anxiety, depression, and Stress Assessment Questionnaire.” The resulting data were analyzed using descriptive statistics, Pearson’s correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05.
Results
A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=–0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep.
Conclusions
Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.

Citations

Citations to this article as recorded by

Effectiveness of psychological nursing interventions for depression, anxiety and mental health resilience: A systematic review and meta-analysis
Xiaodong Wang, Rongfang He, Jiacheng Long, Juan Chen, Monica Karunakaran, Vishnu Shankar Hariharan, Rajan Rushendar, Luwei Xiang
Archives of Psychiatric Nursing.2026; 60: 152042. CrossRef
The Impact of Environmental Stressors on Sleep Quality and Patient Experience in the Intensive Care Unit
Meyreme Aksoy, Zeliha Büyükbayram Genç, Muhammed Ismail Güner
Nursing in Critical Care.2026;[Epub] CrossRef
Frailty and fear of death among geriatric patients in critical care units: A mixed methods study
Eman Arafa Hassan, Shimmaa Mohamed Elsayed, Heba Hashem Monged, Basma Taher Abdelwahab
Nursing in Critical Care.2025;[Epub] CrossRef
Effects of a Multimodal Intervention on Sleep Quality and Duration in Intensive Care Unit Patients
Jieun Nam, Sukhee Ahn
Journal of Korean Critical Care Nursing.2025; 18(1): 70. CrossRef
Sleep Quality and Its Associated Factors among Adult Patients Admitted in the Intensive Care Units of Public Hospitals in Addis Ababa, Ethiopia
Taye Mezgebu Ashine, Birehanu Melaku Kassaye, Asefu Woldestadik, Kasie Gebeyehu Tiruneh, Tadesse Sahle Adeba, Edmialem Getahun Mesfin, Tamrat Alate Woldeyohannis, Asaminew Habtamu Sane
Sage Open Nursing.2025;[Epub] CrossRef
Environmental Factors Affecting Sleep Quality in Intensive Care Unit Patients in Southern Morocco: An Assessment Study
Abdelmajid Lkoul, Keltouma Oumbarek, Youssef Bouchriti, Asmaa Jniene, Tarek Dendane
Advances in Respiratory Medicine.2025; 93(3): 14. CrossRef
Prevalence of poor sleep quality among critical care unit nurses: a systematic review and meta-analysis
Neda Sanaie, Sogand Sarmadi, Akbar Zare-Kaseb
BMC Nursing.2025;[Epub] CrossRef

CPR/Resuscitation
Effects of ketamine on the severity of depression and anxiety following postoperative mechanical ventilation: a single-blind randomized clinical trial in Iran: Seyedbabak Mojaveraghili, Fatemeh Talebi, Sima Ghorbanoghli, Shahram Moghaddam, Hamidreza Shakouri, Ruzbeh Shamsamiri, Fatemeh Mehravar; Acute Crit Care. 2024;39(2):243-250. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01186

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Abstract PDF: Background
In this study, we compare the effects of ketamine and the combination of midazolam and morphine on the severity of depression and anxiety in mechanically ventilated patients after discharge from the intensive care unit (ICU).
Methods
This randomized single-blind clinical trial included 50 patients who were candidates for craniotomy and postoperative mechanical ventilation in the ICU of 5 Azar Teaching Hospital in Gorgan City, North Iran, from 2021 to 2022. Patients were allocated to two groups by quadruple block randomization. In group A, 0.5 mg/kg of ketamine was infused over 15 minutes after craniotomy and then continued at a dose of 5 µ/kg/min during mechanical ventilation. In group B, midazolam was infused at a dose of 2–3 mg/hr and morphine at a dose of 3–5 mg/hr. After patients were discharged from the ICU, if their Glasgow Coma Scale scores were ≥14, Beck’s anxiety and depression inventories were completed by a psychologist within 2 weeks, 2 months, and 6 months after discharge.
Results
The mean scores of depression at 2 months (P=0.01) and 6 months (P=0.03) after discharge were significantly lower in the ketamine group than in the midazolam and morphine group. The mean anxiety scores were significantly lower in the ketamine group 2 weeks (P=0.006) and 6 months (P=0.002) after discharge.
Conclusions
Ketamine is an effective drug for preventing and treating anxiety and depression over the long term in patients discharged from the ICU. However, further larger volume studies are required to validate these results.

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