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Prevalence, Detection and Treatment of Anxiety, Depression, and Delirium in the Adult Critical Care Unit

Received November 27, 2000; revised April 03, 2001; accepted April 18, 2001. From the Adult Critical Care Unit and the Psychiatry Section, Fundacion Valle del Lili Medical Center, Cali, Colombia. Dr. Unutzer is at UCLA NPI Center for Health Services Research, Los Angeles. Dr. Duran is at the University of Miami Health Psychology Division, Miami, FL. Address correspondence to Dr. Rincon, Jefe Seccion de Psiquiatria, Fundacion Clinica Valle del Lili, Cra. 98 # 18 - 49, Cali, Colombia. E-mail: hernanrincon{at}mail.com

This study assesses the levels of depression, anxiety, and delirium during admission to three adult critical care units (CCU) and the performance of CCU staff with respect to detection and treatment. During a 1-month period, 96 consecutive patients were evaluated on the first day of admission by an independent rater, using the Hospital Anxiety Depression Scale and the Confusional Assessment Method. Frequency of alcohol use and demographic data were recorded. CCU teams rarely made diagnoses of anxiety, depression, or delirium. On at least one screening test, 29.2% of patients were positive. Delirium was present in 7.3%, depression in 13.7%, anxiety in 24%, and possible problem drinking in 37.9%. Although some form of psychiatric treatment was offered to 58%, there was low agreement between psychiatric diagnoses made by the independent rater and the diagnoses made and treatments used by CCU staff. This suggests that the CCU staff are using psychotropic medications without any clear documentation and perhaps clear understanding of the psychiatric diagnoses they are treating. In summary, we found high rates of psychiatric disorders in adult CCU patients but low rates of detection and only moderate rates of treatment by CCU staff.

Key Words: Alcohol • Depression • Mental Disorders • Delirium

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