“Patients and their loved ones shouldn’t be afraid if they need life-saving care in the ICU, as the rates of suicide we found are still very low. Our main message to patients is that it’s okay to not be okay after an ICU admission,”-  Dr. Shannon FernandoAn ICU admission is associated with a higher rate of suicide and self-harm after discharge when compared to hospital admissions without an ICU stay, according to the first study of its kind published in the medical journal The BMJ.

“ICU care has advanced in the last decades, and 70 to 80 percent of patients now survive,” said Dr. Shannon Fernando, a critical care fellow at The Ottawa Hospital and the University of Ottawa. “Unfortunately, we know this experience can be traumatic for patients, and will define someone’s health for a long time. These patients are often in hospital for weeks or months and need intense rehabilitation to get their strength back. Once they return home, they may not be able to work full time or at all. We know all of this impacts their mental health. While intuitively all these factors could lead to increased risks of self-harm and suicide, we didn’t have clear data until now.”

A team of researchers from The Ottawa Hospital, the Institut du Savoir Montfort, ICES and the University of Ottawa looked at health records from all ICU survivors in Ontario, Canada from 2009 to 2017. They matched the ICU survivors with hospitalized patients who had similar risk factors for suicide including age, sex, mental health history, and previous hospitalization for self-harm.

Of the 423,000 ICU survivors in the study, 750 (0.2%) died by suicide, compared with 2,427 (0.1%) of the 3 million non-ICU hospital survivors. Self- harm was seen in 5,662 (1.3%) of the ICU survivors compared to 24,411 (0.8%) of the non-ICU hospital survivors.

Overall, analysis showed that ICU survivors had a 22% higher risk of suicide compared with non-ICU hospital survivors and a 15% higher risk of self-harm.“This study can help us evaluate screening criteria for at-risk patients. Suicide is often preventable, and there are things we can do at all levels at healthcare to help,” - Dr. Kwadwo Kyeremanteng

Among the ICU survivors, the highest rates of suicide were seen in younger patients (ages 18-34), those with pre-existing diagnoses of depression, anxiety or PTSD, and those who received invasive procedures such as mechanical ventilation or mechanical blood filtration due to kidney failure in the ICU. Identifying these patients can impact their care, and potentially influence their outcomes after they leave hospital.

“This study can help us evaluate screening criteria for at-risk patients. Suicide is often preventable, and there are things we can do at all levels at healthcare to help.” said Dr. Kwadwo Kyeremanteng, co-senior author on the paper and scientist and critical care physician at The Ottawa Hospital, senior clinician investigator at the Institut du Savoir  Montfort and assistant professor at the University of Ottawa.

The team is conducting further research to better understand the healthcare experience of these higher-risk ICU patients after they leave hospital, “Because of COVID-19, we’re seeing an unprecedented number of ICU admissions worldwide. This is a timely study that shows care should not end when patients leave the hospital, and should address both physical and mental health needs,” -Dr. Peter Tanuseputroincluding how soon they receive outpatient mental health care and whether they are re-hospitalized.

This study’s findings are particularly relevant during the COVID-19 pandemic, as ICU admissions reach all-time highs in Canada and around the world. In Ontario, ICUs are now seeing greater numbers of younger COVID-19 patients who need mechanical ventilation, populations which this study shows are at higher risk of future suicide and self-harm.

“Because of COVID-19, we’re seeing an unprecedented number of ICU admissions worldwide. This is a timely study that shows care should not end when patients leave the hospital, and should address both physical and mental health needs,” said Dr. Peter Tanuseputro, co-senior author, physician-scientist at The Ottawa Hospital and ICES, investigator at the Bruyère Research Institute and assistant professor at the University of Ottawa.

“Patients and their loved ones shouldn’t be afraid if they need life-saving care in the ICU, as the rates of suicide we found are still very low,” said Dr. Fernando. “Our main message to patients is that it’s okay to not be okay after an ICU admission, and as physicians we’re becoming more aware of this.”

Reference: Suicide and self-harm in adult survivors of critical illness: population based cohort study. Shannon M. Fernando, Danial Qureshi, Manish M. Sood, Michael Pugliese, Robert Talarico, Daniel T. Myran, Margaret S. Herridge, Dale M. Needham, Bram Rochwerg, Deborah J. Cook, Hannah Wunsch, Robert A. Fowler, Damon C. Scales, O. Joseph Bienvenu, Kathryn M. Rowan, Magdalena Kisilewicz, Laura H. Thompson, Peter Tanuseputro, Kwadwo Kyeremanteng. The BMJ. May 5, 2021.

Funding: This study was funded by the Institut du Savoir Montfort. Research at The Ottawa Hospital is enabled by generous donations to The Ottawa Hospital Foundation.

Data sources: ICES and the Canadian Institute for Health Information.

About The Ottawa Hospital 
The Ottawa Hospital is one of Canada’s top learning and research hospitals, where excellent care is inspired by research and driven by compassion. As the third-largest employer in Ottawa, our support staff, researchers, nurses, physicians, and volunteers never stop seeking solutions to the most complex health-care challenges. Our multi-campus hospital, affiliated with the University of Ottawa, attracts some of the most influential scientific minds from around the world. Backed by generous support from the community, we are committed to providing the world-class, compassionate care we would want for our loved ones. www.ohri.ca

About Institut du Savoir Montfort

Created in 2015, the Institut du Savoir Montfort (ISM) is a non-profit organization that aims to improve health and the world's health by combining research and education. The ISM relies on collaboration between researchers, educators and andragogues, which facilitates the continuum creation-transmission of knowledge in the organization of health services and the prevention, screening and treatment of physical and mental co-morbidities.

About the University of Ottawa
The University of Ottawa is home to over 50,000 students, faculty and staff, who live, work and study in both French and English. Our campus is a crossroads of cultures and ideas, where bold minds come together to inspire game-changing ideas. We are one of Canada’s top 10 research universities—our professors and researchers explore new approaches to today’s challenges. One of a handful of Canadian universities ranked among the top 200 in the world, we attract exceptional thinkers and welcome diverse perspectives from across the globe. www.uottawa.ca

About ICES

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

Media Contact 
Amelia Buchanan
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Ottawa Hospital Research Institute
613-297-8315
ambuchanan@ohri.ca