Elsevier

Resuscitation

Volume 170, January 2022, Pages 82-91
Resuscitation

Review
Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: A systematic review and meta-analysis

https://doi.org/10.1016/j.resuscitation.2021.11.023Get rights and content

Abstract

Aim

Quality of life after surviving out-of-hospital cardiac arrest (OHCA) is poorly understood, and the risk to mental health is not well understood. We aimed to estimate the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) following OHCA.

Methods

In this systematic review and meta-analysis, databases (MEDLINE, EMBASE, and PsycINFO) were searched from inception to July 3, 2021, for studies reporting the prevalence of depression, anxiety, and PTSD among OHCA survivors. Data abstraction and quality assessment were conducted by two authors independently, and a third resolved discrepancies. A single-arm meta-analysis of proportions was conducted to pool the proportion of patients with these conditions at the earliest follow-up time point in each study and at predefined time points. Meta-regression was performed to identify significant moderators that contributed to between-study heterogeneity.

Results

The search yielded 15,366 articles. 13 articles were included for analysis, which comprised 186,160 patients. The pooled overall prevalence at the earliest time point of follow-up was 19.0% (11 studies; 95% confidence interval [CI] = 11.0–30.0%) for depression, 26.0% (nine studies; 95% CI = 16.0–39.0%) for anxiety, and 20.0% (three studies; 95% CI = 3.0–65.0%) for PTSD. Meta-regression showed that the age of patients and proportion of female sex were non-significant moderators.

Conclusion

The burden of mental health disorders is high among survivors of OHCA. There is an urgent need to understand the predisposing risk factors and develop preventive strategies.

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.

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