Resilience, Quality of life, and Wellbeing in intensive care survivors of Covid-19 critical illness

ABSTRACT

Introduction: The negative impact of Post-Intensive Care Syndrome on the quality of life of critical illness survivors has previously been well characterised.1 Survivors of Covid-19 critical illness are a relatively new cohort in terms of younger age and less prior comorbidity.2 The healthrelated quality of life, psychological problems, resilience, or wellbeing of survivors of Covid-19 critical illness have not been fully explored. Objectives: To characterise the resilience, wellbeing, selfefficacy, and quality of life of ICU-survivors, who were admitted with Covid-19, 6-9 months post-hospital discharge. To explore any potential associations with baseline characteristics. Methods: This was a prospective follow-up study of ICUsurvivor patients who were admitted with Covid-19 and discharged alive from the Royal Infirmary Edinburgh or St John's Hospital, Scotland. Eligible patients were identified by 2 specialist research nurses from the medical records and were contacted via telephone for consent. Paper copies of the questionnaire pack were posted to patients who consented. Demographic characteristics were captured from WardWatcher IT system (age, sex, length of ICU stay). 2 investigators telephoned participants to complete the questionnaires. Outcomes measured were resilience, using the 10-item Connor-Davidson Resilience Scale (CDRISC), self-efficacy, using the General Self-Efficacy (GSE) Scale, overall health state, using The EuroQol EQ5D-5L Health Questionnaire, and Wellbeing, using 6 10-point visual analogue scales. Statistical analysis was conducted using R-Studio. Associations were tested with Fisher's exact test for categorical variables, and Kruskal-Wallis for continuous variables. Statistical significance was accepted at p<=0.05. Results: Of the 52 eligible patients consented to be contacted, 40 (76.9%) completed the questionnaires. 59.6% (31/52) were male;median age was 59.0 (IQR53.0-66.2), and participants spent median 6.3 (IQR 4.1-11.0;) days in ICU. Questionnaires were completed median 202 days (IQR187.5-224.0) from hospital discharge. The median total CDRISC score was 34.5 (IQR 30.8-38.0), which has previously been defined as normal resilience (27-37/40)3. 12.5% (5/40) and 32.5% (13/40) reported low (<27/40) and high (>=38/40) resilience respectively.3 The median total GSE score was 34.0 (IQR 30.0-38.0) (international mean 29.554). For overall health state (EQ5D-5L), the median overall health score was 80.0% (IQR75.0-81.2), with the results in each domain as follows Mobility 27% (11/40) reported moderate or worse problems (with the remainder reporting no problems);Self-care 10% (4/40) reported moderate or worse problems;Usual activities 17% (7/40) reported moderate or worse problems;Pain 17.5% (7/40) reported moderate or worse problems;Anxiety or depression 17.5% (7/40) reported moderate or worse problems. For the wellbeing measures, participants rated 'Overall satisfaction with life as a whole' median 8/10 (IQR 7-9), and 'I have a sense of direction and purpose in life' median 8/10 (IQR7-9.5). Resilience, self-efficacy, health-related quality of life, and wellbeing were not significantly associated with age, length of ICU-stay, or time between discharge and questionnaire completion. Conclusion: Overall, ICU-survivors of Covid-19 critical illness reported normal resilience, and high levels of selfefficacy and wellbeing at 6-9 months post-hospital discharge. Many ICU-survivors experienced problems affecting their overall health state, such as with mobility and pain. Future studies are indicated to investigate how to best support ICU-survivors in their recovery.