51 MENTAL FRAILTY IN ICU-SURVIVORS & INFORMAL CAREGIVER STRAIN 3 findings may be self-evident, aside from the fact that caregiver strain remained high even after patient health status improved. Such discrepancy indicates that it’s essential to include caregivers of patients in ICU-aftercare practices. Although this study comprises valuable data regarding mental frailty post-ICU, there are some limitations to consider. To our knowledge, this is the first time a mental frailty construct is built from the presence of above threshold symptoms of depression, anxiety, and trauma. Nevertheless, the scales used for identification of mental frailty have not been validated for this purpose. To illustrate, even though the TSQ has been validated and used frequently to evaluate post-traumatic stress disorder-related symptoms after critical illness in patients and informal caregivers, it may be less suitable to assess complex trauma or the long-term impact of the often-traumatic ICU-admission.9,28 For research purposes this construct provides valuable information of a patient’s mental vulnerability during ICU-recovery. However, in clinical practice frailty encompasses not only mental health, and both physical and cognitive health should be taken into account when assembling a risk profile. In addition, depression scores at 3-months were included in our prediction model while depression scores at 12-months were used in the outcome measure. Although both variables passed the collinearity test, this could have an impact on the prediction model. Furthermore, despite including extensive information on psychiatric history, this study did not use data on medication use during ICU-stay, sedation techniques, and other factors that may have affected mental recovery. In conclusion, there is a large proportion of ICU-survivors with increasing mental frailty in the first 12-months after critical illness. Psychiatric history at admission and delirium in ICU did not increase the odds for unfavourable outcome. However, depression scores at 3-months may be used as a marker for long-term mental frailty in clinical practice. Future research is needed to investigate the individual trajectories of mental health-related symptoms to uncover the cause of increased depression and anxiety-related symptoms throughout the first year of ICU-recovery. Mixed-method studies, combining qualitative and quantitative outcomes, could provide valuable insights on the natureandextent of long-termmental health-relatedproblems in ICU-survivors. Mental frailty results in HRQoL impairments and higher caregiver burden, which emphasizes the need for integrative aftercare programs for both the patient and their informal caregivers.
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