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Patients who have been admitted to intensive care have a small increased risk of suicide or self harm in future, compared with non-intensive care unit patients, a new study claims.
Researchers in Canada and the US found that ICU survivors had a 22% higher risk of suicide compared with non-ICU hospital survivors and a 15% higher risk of self-harm.
“Future research should identify methods of reducing suicide and self-harm in ICU survivors”
They said: “Survival from critical illness was associated with subsequent suicide and self-harm, with ICU survivors having a higher incidence of these outcomes compared with hospital survivors who never required ICU admission.”
The study, published in the British Medical Journal, looked at the health records of 423,000 adult ICU survivors in Ontario, Canada from 2009 to 2017.
It matched these patients against three million non-ICU hospital survivors in Ontario over the same period who had similar risk factors for suicide.
The findings showed that survivors of critical illness who later died by suicide or had self-harm events tended to be younger with a history of psychiatric illness, and had received invasive life support.
Specifically, the study authors said the highest rates of suicide were seen in patients aged 18-34, those with pre-existing diagnoses of depression, anxiety or post-traumatic stress disorder.
In addition, higher rates were identified in those who received invasive procedures such as mechanical ventilation or mechanical blood filtration due to kidney failure in the ICU.
There has been growing evidence in recent years that ICU survivors exhibit higher rates of psychiatric illness, noted the study authors, but there has previously been no established link with suicide and self-harm.
The findings are particularly relevant during the covid-19 pandemic with the number of ICU admissions around the world at an all-time high, the researchers highlighted.
They argued that, while the overall risk is still very low, the findings could help identify those at greatest risk of suicide.
The factors found to be linked to higher risk “might allow for earlier intervention to potentially reduce this important public health problem”, they said.
However,, given the observational design of the study, the researchers could not rule out the possibility that other unmeasured factors may have affected their results. Their findings, therefore, require further work, they said.
They added: “Future research should identify methods of reducing suicide and self-harm in ICU survivors, particularly those with these additional prognostic factors.”