42 CHAPTER 3 Furthermore, pre-admission mental frailty may affect ICU-survivors in their capability to achieve a meaningful recovery after critical illness. Adding a detailed assessment of psychiatric history, including substance abuse, psychotic disorder, and personality disorders, can help identify specific patients at risk of long-term impairments in mental health. Lastly, including the possibility of an aggravating effect of ICU-related delirium may give essential information regarding the impact of critical illness on long-term mental wellbeing. To this end, this study aims to investigate the prevalence of mental frailty up to 12-months after ICU-admission and pinpoint markers for early risk-assessment in clinical practice. In addition, the presence of psychiatric history or delirium were evaluated as possible predictors for mental frailty. Finally, the impact of mental frailty on patient HRQoL and informal caregiver strain was evaluated. 3.2 MATERIALS AND METHODS 3.2.1 Study design and population In this retrospective single-centre cohort study, all long-stay (≥48h) ICU-patients visiting the specialised outpatient post-ICU clinic between 2012 and 2018 were included. The study was performed in a tertiary teaching hospital in Leeuwarden, The Netherlands. Following local protocol, long-stay ICU-patients visited the outpatient clinic at 3-months after ICU-discharge. At that time point and 12-months after discharge patients and their informal caregivers completed a predefined standard care set of questionnaires. Data from all patients who completed mental wellbeing assessment were retrieved from electronic patient records. As patient-record data were analysed anonymously, the ethical committee waived the need for informed consent (Regionale Toetsingscommissie Patiëntgebonden Onderzoek, Leeuwarden, the Netherlands; nWMO-number: nWMO 358). 3.2.2 Data collection Information regarding demographics, comorbidities, disease aetiology, ICU- morbidity, and post-ICU outcomes were collected from electronic patient records. Psychiatric history was documented as the presence of depression, bipolar disorder, PTSD, anxiety, psychotic illness, personality disorder, or a history of substance abuse based on hospital electronic patient records. Statistics regarding the presence of delirium were obtained from patient records of daily clinical assessment using the Confusion Assessment Method for the ICU
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