• Clara R Medici, Jaimie L Gradus, Lars Pedersen, Henrik T Sørensen, Søren D Østergaard, and Christian F Christiansen.
• 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.2Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark.3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.4National Center for PTSD, VA Boston Healthcare System, Boston, MA.5Department of Psychiatry, Boston University, Boston, MA.6Department of Epidemiology, Boston University, Boston, MA.7Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA.8Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.
• Crit. Care Med. 2017 Oct 1; 45 (10): 1635-1641.

ObjectivesRisk of depression and anxiety is elevated after intensive care. Drugs with anti-inflammatory properties may have antidepressant and anxiolytic effects. The aim of this study was to investigate the association between preadmission use of drugs with anti-inflammatory effects and risk of new-onset depression and anxiety among adult patients admitted to an ICU.DesignPropensity score-matched, population-based cohort study.SettingAll ICUs in Denmark from 2005 to 2013.PatientsAdults receiving mechanical ventilation in an ICU.InterventionsNone.Measurements And Main ResultsA total of 48,207 ICU patients were included. Exposures were preadmission single-agent or combined use of statins, nonsteroidal anti-inflammatory drugs, or glucocorticoids. Outcomes were cumulative incidence (risk) and risk ratio of new-onset psychiatrist-diagnosed depression or anxiety or prescriptions for antidepressants or anxiolytics. Propensity score matching yielded 6,088 statin user pairs, 2,886 nonsteroidal anti-inflammatory drug user pairs, 1,440 glucocorticoid user pairs, and 1,743 combination drug user pairs. The cumulative incidence of anxiety and depression during the 3 years following intensive care was 18.0% (95% CI, 17.0-19.0%) for statin users, 21.3% (95% CI, 19.8-22.9%) for nonsteroidal anti-inflammatory drug users, 17.4% (95% CI, 15.4-19.5%) for glucocorticoid users, and 19.0% (95% CI, 16.3-20.2%) for combination users. The cumulative incidence was similar in nonusers compared with users in all drug groups. The risk ratio of depression and anxiety 3 years after admission to ICU was 1.04 (95% CI, 0.96-1.13) for statin users, 1.00 (95% CI, 0.90-1.11) for nonsteroidal anti-inflammatory drug users, 0.97 (95% CI, 0.82-1.14) for glucocorticoid users, and 1.05 (95% CI, 0.90-1.21) for combination users, compared with nonusers. Results were consistent across subgroups (gender, age, preadmission diseases, type of admission) and sensitivity analyses (depression and anxiety separately).ConclusionsPreadmission use of statins, nonsteroidal anti-inflammatory drugs, glucocorticoids, or combinations did not alter the risk of depression and anxiety after critical illness.

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