Association between sex and mental health sequelae after ICU discharge: A scoping review

Abstract

Background: Following discharge from intensive care units (ICUs), more than 50% of patients may develop mental health conditions including depression, post-traumatic stress disorder (PTSD), and anxiety. However, there is limited research to suggest risk factors and new possibilities for management.

Objective: Are there sex-related differences in the incidence, severity, and duration of mental health sequelae in adults after ICU discharge?

Methods: Studies published in English within the last 20 years, focusing on sex and mental health sequelae post-ICU. Online databases MedLine, EmBASE, Scopus, PsycINFO, and CINAHL were explored as of September 22, 2021.

Results: Of the 706 studies screened, six were included, and three demonstrated a statistically significant association between sex and mental health sequelae. Four outcomes of interest were noted: mental health-related quality of life (HRQoL), post-traumatic stress symptoms (PTSS), major depression/PTSD comorbidity, and major depression. Three studies that addressed mental HRQoL noted a decreased mental HRQoL in females compared to males, but two were statistically significant. No statistically significant association was found between sex and PTSS. One study examined both major depression/PTSD comorbidity and major depression and found a statistically significant association between female sex and both outcomes.

Conclusions: Despite methodological limitations of the identified studies, this scoping review shows a trend for worse mental health outcomes in females post-ICU. More research focusing on confounding factors is needed to better understand the associations between sex, gender, and mental health sequelae in post-ICU patients.