We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Caring for the Critically Ill Patient

Psychiatric Diagnoses and Psychoactive Medication Use Among Nonsurgical Critically Ill Patients Receiving Mechanical Ventilation

Hannah Wunsch, MD, MSc1,2; Christian F. Christiansen, MD, PhD3,4; Martin B. Johansen, MSc3; Morten Olsen, MD, PhD3; Naeem Ali, MD5; Derek C. Angus, MD, MPH6,7; Henrik Toft Sørensen, MD, PhD, DSc3
[+] Author Affiliations
1Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York
2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
4Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
5Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus
6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
7Associate Editor, JAMA
JAMA. 2014;311(11):1133-1142. doi:10.1001/jama.2014.2137.
Text Size: A A A
Published online

Importance  The relationship between critical illness and psychiatric illness is unclear.

Objective  To assess psychiatric diagnoses and medication prescriptions before and after critical illness.

Design, Setting, and Participants  Population-based cohort study in Denmark of critically ill patients in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population.

Exposures  Critical illness defined as intensive care unit admission with mechanical ventilation.

Main Outcomes and Measures  Adjusted prevalence ratios (PRs) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox regression.

Results  Among 24 179 critically ill patients, 6.2% had 1 or more psychiatric diagnoses in the prior 5 years vs 5.4% for hospitalized patients (adjusted PR, 1.31; 95% CI, 1.22-1.42; P<.001) and 2.4% for the general population (adjusted PR, 2.57; 95% CI, 2.41-2.73; P<.001). Five-year preadmission psychoactive prescription rates were similar to hospitalized patients: 48.7% vs 48.8% (adjusted PR, 0.97; 95% CI, 0.95-0.99; P<.001) but were higher than the general population (33.2%; adjusted PR, 1.40; 95% CI, 1.38-1.42; P<.001). Among the 9912 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low but higher than hospitalized patients: 0.5% vs 0.2% over the first 3 months (adjusted HR, 3.42; 95% CI, 1.96-5.99; P <.001), and the general population cohort (0.02%; adjusted HR, 21.77; 95% CI, 9.23-51.36; P<.001). Risk of new psychoactive medication prescriptions was also increased in the first 3 months: 12.7% vs 5.0% for the hospital cohort (adjusted HR, 2.45; 95% CI, 2.19-2.74; P<.001) and 0.7% for the general population (adjusted HR, 21.09; 95% CI, 17.92-24.82; P<.001). These differences had largely resolved by 9 to 12 months after discharge.

Conclusions and Relevance  Prior psychiatric diagnoses are more common in critically ill patients than in hospital and general population cohorts. Among survivors of critical illness, new psychiatric diagnoses and psychoactive medication use is increased in the months after discharge. Our data suggest both a possible role of psychiatric disease in predisposing patients to critical illness and an increased but transient risk of new psychiatric diagnoses and treatment after critical illness.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal


Place holder to copy figure label and caption
Cumulative Incidence Curves of New Psychiatric Diagnoses or Prescriptions

Top, One or more new psychiatric diagnoses by a psychiatrist. Bottom, New prescriptions for psychoactive medication during the 1 year of follow-up among the cohort of patients receiving mechanical ventilation with no 5-year prior history of any psychiatric diagnosis or prescriptions for psychoactive medications. For the overall diagnosis and drug analyses patients are censored at first diagnosis or drug. For individual diagnosis or drugs patients are followed up for each outcome.

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia

Author Interview

Articles Related By Topic
Related Collections
PubMed Articles