PhD Student University of Edinburgh, United Kingdom
Background: Over half of critical illness survivors manifest some form of psychiatric morbidity after hospital discharge. Few publications examine psychotropic prescribing in patients after critical illness with appropriate comparator groups.
Objectives: Our first aim was to examine prescribing after critical illness in all survivors grouped by: 1) any psychotropic (aggregate of the following); 2) antidepressants; 3) anxiolytics or hypnotics; and 4) antipsychotics or mania drugs. Our second aim was to examine the incidence of new psychotropic drug prescribing after hospitalisation, comparing critical care survivors to non-critical care hospitalised survivors in the Lothian region of Scotland.
Methods: This retrospective cohort study used anonymised, linked patient records for all adults hospitalised with or without critical care in Lothian, Scotland between 2012 and 2019, and who survived to discharge. We assessed prescribing information within 180 days before hospitalisation and 90 days after hospital discharge. We compared the psychotropic-naïve critical care survivors to psychotropic naïve non-critical care hospitalised survivors, selecting one random hospitalisation per individual. We calculated the cumulative incidences of new prescriptions. Cause-specific hazards ratios (HR) with 95% confidence intervals were estimated, both unadjusted and adjusted for sex, age group, deprivation quintile, main condition at hospital admission, comorbidity category, previous hospital admissions category, and previous emergency attendances category.
Results: One-third of critical care survivors (32%; 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25% antidepressants; 14% anxiolytics or hypnotics, and 4% antipsychotics or mania drugs). In comparison, 15% (54,589/367,185) of non-critical care survivors received a psychotropic (12% antidepressants; 5% anxiolytics or hypnotics, 2% antipsychotics or mania drugs). In the psychotropic-naïve survivors, the critical care group had a higher incidence of a psychotropic prescription within 90 days of hospital discharge (10.3% (1610/15,609)) compared with the non-critical care group (3.2% (9743/307,429)); unadjusted HR 3.39, 95% CI: 3.22 – 3.57. After adjustment for confounders, the risk remained elevated (adjusted HR 2.03, 95% CI: 1.91 – 2.16).
Conclusions: One in ten survivors of critical illness received a new prescription for psychotropic medication within 90 days of hospital discharge. Future research should focus on the requirement for and safety of psychotropic medications in survivors of critical illness, to help guide policy for clinical practice.
