Major Psychiatric Disorders Risk is Elevated in Pediatric ICU Survivors
—A nationwide study in Taiwan found that children and adolescents who received intensive care treatment have a significantly increased risk of developing various major psychiatric disorders.
A new study by Ping-Chung Wu, from the Department of Psychiatry at Taipei Veterans General Hospital in Taiwan, and colleagues published in the Journal of Affective Disorders has uncovered a concerning trend: children and adolescents who survive a stay in the intensive care unit (ICU) face a significantly higher risk of developing major psychiatric disorders (MPDs) later in life compared to their peers. This finding underscores the importance of recognizing the long-term mental health consequences of critical illness in young patients and developing appropriate interventions.1
While previous research has explored the potential for negative psychiatric outcomes following a pediatric ICU stay, much of this work has focused on post-traumatic stress disorder (PTSD) and depression or anxiety.2,3 Additionally, many prior studies had smaller sample sizes and focused on specific geographic regions, potentially limiting the generalizability of the results.4,5 Recognizing these limitations, this new study aimed to investigate the risk of a wider range of MPDs—including schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and PTSD—in a large, nationwide sample of child and adolescent ICU survivors in Taiwan.1
A nationwide look at psychiatric risk
The researchers utilized data from Taiwan's National Health Insurance Research Database (NHIRD), a comprehensive dataset covering over 99% of the Taiwanese population. From 1996 to 2013, they identified 8704 child and adolescent ICU survivors with no prior history of MPDs and matched them with 87,040 controls based on age, sex, family income, and residential area, excluding anyone who died prior to 2013. The researchers tracked the incidence of new MPD diagnoses in both groups from the time of ICU admission (or enrollment for controls) until the end of 2013.1
Compared to controls, child and adolescent ICU survivors (mean age 10.33 years) had a significantly higher risk of developing all five MPDs investigated (PTSD, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and major depressive disorder). A subanalysis looking at the types of critical illness leading to ICU admission revealed that certain illnesses were associated with higher risks for specific MPDs. For example, survivors of respiratory system diseases showed the highest risk for bipolar disorder (HR 3.97, 95% CI 1.75–9.02), while survivors of injuries and poisoning had the highest risk for PTSD (HR 7.03, 95% CI 3.39–14.58). Interestingly, a longer ICU stay (≥3 days) was also associated with a significantly higher risk of developing several MPDs, suggesting that prolonged exposure to the ICU environment may be a contributing factor.1
Beyond the overall increased risk, the study also examined how the risk of developing each specific MPD varied across different types of critical illness leading to ICU admission. This analysis revealed a complex pattern of associations. For example, survivors of diseases affecting the nervous system and sense organs showed a particularly high risk for schizophrenia, while those who experienced pregnancy or childbirth-related complications had a higher risk of developing major depressive disorder. Interestingly, a diagnosis related to diseases of the genitourinary system was specifically linked to a heightened risk of obsessive-compulsive disorder. This granular analysis provides a more nuanced understanding of the potential long-term psychiatric risks associated with different types of critical illness experienced during childhood and adolescence.1
The study has several limitations inherent to its retrospective design. It relied on diagnostic codes within the NHIRD, meaning the true incidence of MPDs may be underestimated due to cases not seeking medical attention or receiving a formal diagnosis. Furthermore, the database does not provide information on potential confounding variables such as psychosocial factors, family history of mental illness, or specific treatments received, which could influence the development of MPDs.1
Early intervention is key
Despite the limitations, this study highlights a critical need for increased awareness and attention to the long-term mental health needs of this vulnerable population. As the authors state, “the development of appropriate MPD prevention strategies should be emphasized for child and adolescent ICU survivors.” The findings suggest that proactive screening for mental health issues following an ICU stay, particularly for those with longer stays or specific diagnoses associated with higher MPD risk, could be crucial for early identification and intervention.1
This research also points to a need for future studies to further explore the underlying mechanisms driving the association between critical illness and MPDs. Investigating the potential role of inflammation, stress, genetic predisposition, and other biological and psychosocial factors could inform the development of targeted preventive and therapeutic interventions to support the long-term well-being of young ICU survivors.1
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