196 CHAPTER 9 identificationmethodmay be used as amarker for overall physical non-recovery in the first year after ICU-admission. Applying these composite measures for health status can therefore be used to identify patients at risk and adjust treatment or rehabilitation protocol at an early stage of recovery, resulting in personalised and targeted (after)care and possibly a more meaningful recovery. In addition to physical non-recovery, survivors of critical illness may experience a wide variety of mental health problems.7,8 Despite common belief, it is not always possible to trace back these problems to risk factors like psychiatric history or episodes of delirium during ICU-stay.9,10 Nevertheless, it is prudent to identify patients at risk for long-term mental health problems after ICU- admission. In Chapter 3 the commonly known concept of frailty is adopted to grasp the interconnected nature of mental health problems in ICU-survivors. Where previous research predominantly focussed on isolated symptoms of depression, anxiety, and trauma, this chapter discusses the use of the presence of above-threshold symptoms to identify patients at risk of long-term non-recovery in mental health, i.e. being mentally frail. Using this method, 38% of survivors were found to be mentally frail at 12-months after ICU-admission. In addition, mental frailty was associated with impairments in overall HRQoL, a more emotion-orientated coping strategy, and higher caregiver burden in the first year of recovery. Similar to the findings on physical functioning discussed in chapter 2, mental frailty was already detectable at the three month follow up visit. Early identification of these patients is essential and provides researchers with the opportunity to investigate the effects of reduced mental health on a personal and system level. Combining the findings of these two chapters, there is a clear implication of early screening – at the specialised outpatient clinic – to identify patients and caregivers in need for additional support. To improve this identification of patients and caregivers at risk, more detailed and robust information is needed on the implications of a lack of recovery. Previous research on HRQoL of ICU-survivors is abundant, but often limited to retrospective group-orientated analyses.5,11 To substantiate the finding that a large proportion of ICU-survivors does not fully recover in the first year after ICU-admission, Chapter 4 elaborates on a prospective study on HRQoL trajectories and their correlation with work-related activities, the patient’s healthcare needs, and caregiver burden. In this study, more than half of the patients were allocated to the physical non-recovery group using the identification method applied in Chapter 2. Although there were no clinically relevant differences in pre-admission frailty, this group had a lower physical HRQoL in the three months before ICU-admission compared to those who did meet the
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