ReviewPrevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: A systematic review and meta-analysis
Introduction
Out-of-hospital cardiac arrest (OHCA) is a major public health problem with a global average incidence of 83.7 cases per 100,000 person-years1 and a 1-year survival rate of 7.7%.2 With increasingly sophisticated resuscitative interventions, more patients who experience OHCAs are surviving the initial event,1., 3., 4., 5. resulting in growing (and sometimes sizable) cohorts of survivors in some communities.6., 7. There are hence unanswered questions of mounting clinical and public health relevance regarding the natural progression of the OHCA survivorship condition.
Like other major illnesses involving ischemic injury to the brain, such as acute ischemic stroke, hemorrhagic stroke, or traumatic brain injury, OHCA is expected to affect both the physiological and psychosocial aspects of the lives of survivors. Brain injury from both the initial anoxia and the subsequent ischemia reperfusion injury can precipitate adverse psychological outcomes, including the development of anxiety, depression, and social functioning difficulties.8 This has not been well-understood as the OHCA survivors were previously few in number and often not followed-up systematically. Additionally, the existing literature has often focused on counting survivors, or at best, quantifying neurological outcomes using tools such as the Glasgow-Pittsburgh Cerebral Performance Categories (CPC) or the Modified Rankin Scale.9 There is a need to gain a more sophisticated understanding of the health-related quality of life (HRQoL) among survivors in more dimensions and resolution. The unpredictable and devastating nature of OHCA is a major disruption to the lives of patients.10., 11. Patients may no longer be able to engage in activities that were once easily undertaken and must now depend on others for care. These lived realities and difficult transitions may give rise to severe distress and feelings of vulnerability and hopelessness.11., 12. There may also be increased anxiety and insecurity about their inability to cope as they grapple with concerns of rehabilitation demands and the risk of OHCA recurrence and other complications.10., 11., 13.
As such, OHCA is expected to be a risk factor for the subsequent development of anxiety and depression.9., 14., 15., 16., 17., 18. To the best of our knowledge, there has not been a meta-analysis on the impact on mental health in OHCA survivors. A previous systematic review comprising both in-hospital cardiac arrest (IHCA) and OHCA patients reported that the incidence rates of depression, anxiety, and PTSD ranged from 14–45%, 13–61%, and 19–27% respectively.9 There were also insufficient studies at the time of that systematic review to obtain pooled estimates of the prevalence. This systematic review and meta-analysis therefore aimed to estimate the prevalence of mental illness following OHCA population.
Section snippets
Methods
This systematic review and meta-analysis adhered to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.19., 20. The study protocol has been published in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42021279451).
Literature retrieval and summary of included articles
The database search yielded 15,366 records, from which 3,434 duplicates were removed. Of the remaining 11,932 records, 11,663 were excluded on the basis of their titles and abstracts. Following this, 247 full texts were reviewed, resulting in five articles identified as meeting the selection criteria. An additional eight articles were identified from reviewing references of eligible articles. Ultimately, 13 articles were eligible for analysis. The detailed selection process and reasons for
Discussion
From our study, the prevalence of depression, anxiety, and PTSD in OHCA survivors were 19.0%, 26.0%, and 20.0% respectively. To our knowledge, this is the first meta-analysis on the prevalence of mental illness among OHCA survivors. In the general population, the prevalence of depression, anxiety, and PTSD are approximately 12.9%,48 7.3%,49 and 3.9%50 respectively. Accordingly, the prevalence of depression among OHCA survivors was 1.5 times that of the general population while the prevalence of
Conclusion
In conclusion, this meta-analysis found that the burden of anxiety, depression, and PTSD is high among OHCA patients. The prevalence of these disorders are comparably higher than in the general population. While it is reassuring that there are evidence-based treatments for depression, anxiety, and PTSD, more steps should be taken to improve the physical and mental outcomes of OHCA survivors. Psychological screening should be implemented early, and further research in the OHCA survivor
Data availability statement
Abstracted data are available on reasonable request to the corresponding author.
Funding
AFWH was supported by the Estate of Tan Sri Khoo Teck Puat (Khoo Clinical Scholars Programme), Khoo Pilot Award (KP/2019/0034), Duke-NUS Medical School and National Medical Research Council (NMRC/CS_Seedfd/012/2018).
CRediT authorship contribution statement
Clyve Yu Leon Yaow: Conceptualization, Data Curation, Formal Analysis, Methodology, Project administration, Writing - original draft, Writing - review & editing. Seth En Teoh: Conceptualization, Data Curation, Formal Analysis, Methodology, Project administration, Writing - original draft, Writing -review & editing. Wei Shyann Lim: Data Curation, Writing - original draft. Renaeta Shi Qi Wang: Data Curation, Writing - original draft. Ming Xuan Han: Data Curation, Writing - original draft. Pin Pin
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
We are grateful to Ms. Wong Suei Nee from the Medical Library, National University of Singapore, for her assistance in our search strategy. We also acknowledge the assistance of Mr. Daryl Jimian Lin in administrative support which was crucial to the completion of this study.
References (72)
- et al.
Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies
Resuscitation
(2010) - et al.
Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC)
Resuscitation
(2015) - et al.
Long-term survival among OHCA patients who survive to 30 days: Does initial arrest rhythm remain a prognostic determinant?
Resuscitation
(2021) - et al.
Long term survival and costs per life year gained after out-of-hospital cardiac arrest
Resuscitation
(2004) - et al.
The psychosocial outcomes of anoxic brain injury following cardiac arrest
Resuscitation
(2014) - et al.
Anxiety, depression, and PTSD following cardiac arrest: a systematic review of the literature
Resuscitation
(2013) - et al.
Trapped in a disrupted normality: Survivors' and partners' experiences of life after a sudden cardiac arrest
Resuscitation
(2020) - et al.
The prevalence of psychiatric disorders in sudden cardiac arrest survivors: A 5-year nationwide inpatient analysis
Resuscitation
(2019) - et al.
Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy
Resuscitation
(2015) - et al.
Anxiety and depression among out-of-hospital cardiac arrest survivors
Resuscitation
(2015)
Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest: The Hanox Study
Chest
Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest
Resuscitation
Health-related quality of life after out-of-hospital cardiac arrest - a five-year follow-up study Jurate Saltyte Benth
Resuscitation
Moving from physical survival to psychologic recovery: a qualitative study of survivor perspectives on long-term outcome after sudden cardiac arrest
Resusc Plus
A biopsychosocial model of fatigue and depression following stroke
Med Hypotheses
The validity of the Hospital Anxiety and Depression Scale. An updated literature review
J Psychosom Res
Prevalence of vitamin D deficiency in Africa: a systematic review and meta-analysis
Lancet Glob Health
Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2·3 million patients with tuberculosis
Lancet Glob Health
The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis
Crit Care
The Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network: what, where, why and how
Singapore Med J
Improving Temporal Trends in Survival and Neurological Outcomes After Out-of-Hospital Cardiac Arrest
Circ Cardiovasc Qual Outcomes
Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association
Circulation
A Meta-ethnography of Out-of-Hospital Cardiac Arrest Survivors' Meanings on Life and Death
J Cardiovasc Nurs
Prevention of mood disorder after stroke: a randomised controlled trial of problem solving therapy versus volunteer support
BMC Neurol
Life change events and mental illness: an overview
J Human Stress
Prevalence of depression after stroke: the Perth Community Stroke Study
Br J Psychiatry
Mood disorders in the year after first stroke
Br J Psychiatry
Prevalence of depression in survivors of acute myocardial infarction
J Gen Intern Med
Myocardial infarction and generalised anxiety disorder: 10-year follow-up
Br J Psychiatry
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group
JAMA
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews
BMJ
Estimating the mean and variance from the median, range, and the size of a sample
BMC Med Res Methodol
Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range
BMC Med Res Methodol
How to perform a meta-analysis with R: a practical tutorial
Evid Based Ment Health
Seriously misleading results using inverse of Freeman-Tukey double arcsine transformation in meta-analysis of single proportions
Res Synth Methods
Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies
Int J Stroke
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2023, The Lancet Regional Health - Western PacificCitation Excerpt :Extensive research has been conducted on factors associated with short-term survival following OHCA.9–11 Recently, however, increased focus has been placed on the long-term outcomes of OHCA,12–14 including long-term survival and health-related quality of life during the additional years of life lived,12,15–17 which help evaluate the natural history and long-term impact of OHCA on the health burden of society.12,18,19 To quantify both the fatal and non-fatal disease burden of OHCA, several recent articles had applied the concept of disability-adjusted life years (DALYs) to OHCA.19–21