Childhood ICU Stays Linked to Higher Risk of Mental Illness Years Later

Children and adolescents who have been admitted to an intensive care unit (ICU) may have a higher risk of mental illness years later compared with those who have never been to an ICU, a study in the Journal of Affective Disorders has found. Further, the risks for specific mental illnesses varied depending on the condition underlying the ICU admission.

Ping-Chung Wu, M.D., of the Taipei Veterans General Hospital in Taiwan, and colleagues examined data from Taiwan’s National Health Insurance program for 8,704 individuals who were admitted to an ICU as children or adolescents (mean age 10.33) between 1996 and 2013 and survived their ICU stay. The researchers matched these ICU survivors to 87,040 individuals without ICU stays (controls) according to age, sex, family income, and residence. Follow-up ranged from one month to roughly 17 years, with a mean follow-up of about 9.6 years.

Compared with the control group, patients who had been admitted to the ICU had an increased risk of the following mental illnesses during follow-up:

• 4.67 times the risk of posttraumatic stress disorder (PTSD)
• 3.19 times the risk of schizophrenia
• 2.02 times the risk of bipolar disorder
• 1.96 times the risk of obsessive-compulsive disorder (OCD)
• 1.68 times the risk of major depressive disorder

Patients who had an ICU stay of three days or more had a higher risk of these conditions compared with those whose ICU stay was less than three days, except for bipolar disorder.

Risk among patients admitted to an ICU varied according to the conditions that prompted the ICU stay. For example, the risk of schizophrenia was highest among patients admitted for diseases of the blood and blood-forming organs, the nervous system, and the digestive system. Risk for PTSD was highest in patients admitted for respiratory diseases, while risk of OCD was highest in patients with genitourinary diseases.

“The subanalysis results stratified by type of critical illness can help clinicians to establish optimal MPD [major psychiatric disorder] screening and prevention strategies for high-risk groups; they can also serve as clinical evidence for future research on the etiologies of MPDs,” Wu and colleagues wrote. “Given our study results, the development of appropriate MPD prevention strategies should be emphasized for child and adolescent ICU survivors.”

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Posttraumatic Stress Symptoms Among COVID-19 Survivors After Hospitalization.”

(Image: Getty Images/iStock/gorodenkoff)

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Very Young Children Exposed to Anesthesia May Be at Higher Risk of Childhood Bipolar Disorder

Infants and toddlers who are exposed to general anesthesia may be at increased risk for bipolar disorder later in childhood compared with infants and toddlers who are not exposed, according to a report in Schizophrenia Bulletin. The association remained after adjusting for other childhood comorbidities and parental psychiatric diagnoses.

“In the context of pediatric care, it is essential to recognize the substantial perioperative trauma experienced by children, both physically and psychologically,” wrote Mingyang Sun, M.D., of the People’s Hospital of Zhenghzou University in Henan, China, and colleagues. “Emerging evidence underscores the significant impact of early-life exposure to multiple anesthetics on neurodevelopment.”

The researchers compared the incidence of pediatric bipolar disorder in 7,535 children in Taiwan who were exposed to general anesthesia at age 3 or younger between 2004 and 2014 with that of an equal number of children who were not exposed. Data were drawn from the Taiwan Maternal and Child Health Database. The two groups of children were matched for other variables associated with bipolar risk, including premature birth, head injury, sexual abuse, malnutrition, toxic exposure, congenital abnormalities, and parental psychiatric illness.

A total of 223 (3%) of the children who were exposed to general anesthesia were diagnosed with bipolar disorder before age 12 compared with 178 (2.4%) of those who were not exposed. Children exposed to general anesthesia were 1.26 times more likely to develop bipolar disorder before age 12.

Sun and colleagues noted that general anesthesia’s potential to increase the risk of developing bipolar disorder involves intricate mechanisms, including neurotoxicity associated with specific anesthetic agents and disruptions in neural pathways. Sevoflurane, a commonly employed inhalation anesthetic, has garnered particular attention due to its neurotoxic effects, they wrote, but adding, “our study didn’t examine specific anesthetic agents’ effects on [bipolar disorder] development, an area ripe for future research to inform precise anesthesia choices and mitigate [bipolar disorder] risk in children.”

(Image: Getty Images/iStock/FatCamera)

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