Factors Related to Health-related Quality of Life Among Critical Illness Survivors, Sichuan Province, the People's Republic of China: A Cross-sectional Study
Keywords:
Activities of daily living, Anxiety, Depression, Health-related quality of life, Critical illness survivorsAbstract
Health-Related Quality of Life (HRQOL) affected by critical illness and ICU treatment, of those who have moved out of an intensive care unit. The sequela of critical illness contributes to Activity of Daily Living (ADL) problems, anxiety, and depression. This descriptive correlational study explored the relationship of HRQOL with ADL, anxiety, and depression among critically ill survivors in Chengdu Fifth People’s Hospital, Sichuan Province, the People’s Republic of China. The participants included 85 critical illness survivors. Research instruments included the demographic data of participants, and Chinese versions of the Short Form 36-item Health Status survey (SF-36), the Katz ADL scale, and the Hospital Anxiety Depression (HAD) Scale. The Cronbach’s alpha coefficient for the SF-36 was 0.98, 0.97, 0.99, 0.91, 0.96, 0.88, 0.87, and 0.91 for the physical function, role physical, role emotion, social function, bodily pain, vitality, mental health, and general health dimensions, respectively. For the Chinese version of the Hospital Anxiety Depression (HAD) Scale, the Cronbach's alpha coefficients for anxiety and depression were 0.84 and 0.83, respectively. The one-week test-retest reliability for the Katz ADL was 1.00. Descriptive statistics, Spearman’s rank correlation, and Mann-Whitney U tests were used in this study.
The study results showed that bodily pain received the highest HRQOL score in all dimensions among critical illness survivors (M = 91.54, SD = 16.80). The lowest average rating was for the general health dimension (M = 70.86, SD = 16.06). Role emotion, mental health, social function, physical role, physical function, and vitality were at the moderate average rating and were gradually declining, at 87.50, 86.22, 85.70, 80.10, 78.02, and 77.74, respectively. Most participants had ADL independence (n = 67, 78.80%). In addition, most participants showed no anxiety (n = 76, 89.50%) or depression (n = 75, 88.20%). Anxiety had a slight relationship with HRQOL in physical function and physical role (r = -.214, -.213, p < 0.05), a moderate relationship with general health (r = -. 454, p < 0.01), and a strong relationship with role emotion, social function, vitality, and mental health (r = -.514 to -.724, p < 0.01). In addition, depression had a moderate to strong negative relationship with HRQOL in seven dimensions except for the bodily pain dimension (r = -.478 to -.685, P < 0.01).
The results of this study provide evidence supporting strategies to enhance HRQOL among survivors of critical illness in Chengdu, Sichuan province. These strategies focus on improving activities of daily living as well as reducing anxiety and depression among this population.
References
American Psychiatric Association. (2013). Anxiety disorders. In diagnostic and statistical manual of mental disorders (5th ed., pp.189-233). https://shorturl.asia/s0ZAw
Battle, C., James, K., & Temblett, P. (2015). Depression following critical illness: Analysis of incidence and risk factors. Journal of the Intensive Care Society, 16(2), 105–108. https://doi.org/10.1177/1751143714559904
Bienvenu, O. J., Colantuoni, E., Mendez-Tellez, P. A., Dinglas, V. D., Shanholtz, C., Husain, N., Dennison, C. R., Herridge, M. S., Pronovost, P. J., & Needham, D. M. (2012). Depressive symptoms and impaired physical function after acute lung injury: A 2-year longitudinal study. American Journal of Respiratory and Critical Care Medicine, 185(5), 517–524. https://doi.org/10.1164/rccm.201103-0503OC
Busico, M., Intile, D., Sívori, M., Irastorza, N., Alvarez, A. L., Quintana, J., Vazquez, L., Plotnikow, G., Villarejo, F., & Desmery, P. (2016). Risk factors for worsened quality of life in patients on mechanical ventilation. A prospective multicenter study. Medicina Intensiva, 40(7), 422–430. https://doi.org/10.1016/j.medin.2016.01.002
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Routledge. https://doi.org/10.4324/9780203771587
Fiani, B., Figueras, R. A., Samones, P., Lee, C., Castillo, A., Sangalang, B., & Garcia Perez, F. (2022). Long-term Intensive Care Unit (ICU) stays can lead to Long-Term Cognitive Impairment (LTCI): Neurosurgery nursing strategies to minimize risk. Cureus, 14(9), e28967. https://doi.org/10.7759/cureus.28967
Gibney, R. T. N., Blackman, C., Gauthier, M., Fan, E., Fowler, R., Johnston, C., Katulka, R. J., Marcushamer, S., Menon, K., Miller, T., Paunovic, B., & Tanguay, T. (2022). COVID-19 pandemic: The impact on Canada’s intensive care units. Facets, 7, 1411–1472. https://doi.org/10.1139/facets-2022-0023
Griffiths, J., Hatch, R. A., Bishop, J., Morgan, K., Jenkinson, C., Cuthbertson, B. H., & Brett, S. J. (2013). An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: A 12-month follow-up study. Critical Care, 17(3), R100. https://doi.org/10.1186/cc12745
Hatch, R., Young, D., Barber, V., Griffiths, J., Harrison, D. A., & Watkinson, P. (2018). Anxiety, depression and post traumatic stress disorder after critical illness: A UK-wide prospective cohort study. Critical Care (London, England), 22(1), 310. https://doi.org/10.1186/s13054-018-2223-6
He, H., Ma, X., Su, L., Wang, L., Guo, Y., Shan, G., He, H. J., Zhou, X., Liu, D., Long, Y., Zhao, Y., & Zhang, S. (2020). Effects of a national quality improvement program on ICUs in China: A controlled pre-post cohort study in 586 hospitals. Critical Care, 24(1), 73. https://doi.org/10.1186/s13054-020-2790-1
Herridge, M. S., Moss, M., Hough, C. L., Hopkins, R. O., Rice, T. W., Bienvenu, O. J., & Azoulay, E. (2016). Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Medicine, 42(5), 725–738. https://doi.org/10.1007/s00134-016-4321-8
Hodgson, C. L., Haines, K. J., Bailey, M., Barrett, J., Bellomo, R., Bucknall, T., Gabbe, B. J., Higgins, A. M., Iwashyna, T. J., Hunt-Smith, J., Murray, L. J., Myles, P. S., Ponsford, J., Pilcher, D., Udy, A. A., Walker, C., Young, M., Jamie Cooper, D. J., & ICU-Recovery Investigators. (2018). Predictors of return to work in survivors of critical illness. Journal of Critical Care, 48, 21–25. https://doi.org/10.1016/j.jcrc.2018.08.005
Hofhuis, J. G. M., Schrijvers, A. J. P., Schermer, T., & Spronk, P. E. (2021). Health-related quality of life in ICU survivors-10 years later. Scientific Reports, 11(1), 15189. https://doi.org/10.1038/s41598-021-94637-z
Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., Pun, B. T., Vasilevskis, E. E., Morandi, A., Shintani, A. K., Hopkins, R. O., Bernard, G. R., Dittus, R. S., & Ely, E. W. (2014). Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: A longitudinal cohort study. The Lancet, Respiratory Medicine, 2(5), 369–379. https://doi.org/10.1016/S2213-2600(14)70051-7
Johnson, R. F. Jr., & Gustin, J. (2013). Acute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: Impact on managing uncertainty for patient-centered communication. The American Journal of Hospice & Palliative Care, 30(6), 569–575. https://doi.org/10.1177/1049909112460566
Katz, S., Ford A. B., Moskowitz R. W., Jackson B. A., & Jaffe M. W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914-919. https://doi.org/10.1001/jama.1963.03060120024016
Leung, C. M., Ho, S., Kan, C. S., Hung, C. H., & Chen, C. N. (1993). Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. International Journal of Psychosomatics: Official Publication of the International Psychosomatics Institute, 40(1–4), 29–34.
Liu, J., Qu, B., Hu, B., Jiang, N., & Wang, D. (2013). The quality of life of men who have sex with men in China: Reliability and validity testing of the SF-36 questionnaire. PLOS ONE, 8(12), e83362. https://doi.org/10.1371/journal.pone.0083362
Li, L., Wang, H. M., & Shen, Y. (2003). Chinese SF-36 Health Survey: Translation, cultural adaptation, validation, and normalisation. Journal of Epidemiology and Community Health, 57(4), 259–263. https://doi.org/10.1136/jech.57.4.259
Liu, N., Zeng, L., Li, Z., & Wang, J. (2013). Health-related quality of life and long-term care needs among elderly individuals living alone: A cross-sectional study in rural areas of Shaanxi Province, China. BMC Public Health, 13, 313. https://doi.org/10.1186/1471-2458-13-313
Li, R., Zhou, Y., Liu, X., Huang, J., Chen, L., Zhang, H., & Li, Y. (2021). Functional disability and post-traumatic stress disorder in survivors of mechanical ventilation: A cross-sectional study in Guangzhou, China. Journal of Thoracic Disease, 13(3), 1564–1575. https://doi.org/10.21037/jtd-20-2622
Liao, K. M., Ho, C. H., Lai, C. C., Chao, C. M., Chiu, C. C., Chiang, S. R., Wang, J. J., Chen, C. M., & Cheng, K. C. (2020). The association between depression and length of stay in the intensive care unit. Medicine, 99(23), e20514. https://doi.org/10.1097/MD.0000000000020514
McKinley, S., Fien, M., Elliott, R., & Elliott, D. (2016). Health-related quality of life and associated factors in intensive care unit survivors 6 months after discharge. American Journal of Critical Care, 25(1), 52–58. https://doi.org/10.4037/ajcc2016995
Medhi, G. K., Sarma, J., Pala, S., Bhattacharya, H., Bora, P. J., & Visi, V. (2019). Association between health related quality of life (HRQOL) and activity of daily living (ADL) among elderly in an urban setting of Assam, India. Journal of Family Medicine and Primary Care, 8(5), 1760–1764. https://doi.org/10.4103/jfmpc.jfmpc_270_19
Müller, A., Von Hofen-Hohloch, J., Mende, M., Saur, D., Fricke, C., Bercker, S., Petros, S., & Classen, J. (2020). Long-term cognitive impairment after ICU treatment: A prospective longitudinal cohort study (Cog-I-CU). Scientific Reports, 10(1), 15518. https://doi.org/10.1038/s41598-020-72109-0
Nakamura, K., Kawasaki, A., Suzuki, N., Hosoi, S., Fujita, T., Hachisu, S., Nakano, H., Naraba, H., Mochizuki, M., & Takahashi, Y. (2021). Grip strength correlates with mental health and quality of life after critical care: A retrospective study in a post-Intensive care syndrome clinic. Journal of Clinical Medicine, 10(14), 3044. https://doi.org/10.3390/jcm10143044
National Health Commission. (2020). Medical services and medical quality safety in China in 2019. http://www.gov.cn/zhengce/index.htm
Nikayin, S., Rabiee, A., Hashem, M. D., Huang, M., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Anxiety symptoms in survivors of critical illness: A systematic review and meta-analysis. General Hospital Psychiatry, 43, 23–29. https://doi.org/10.1016/j.genhosppsych.2016.08.005
Pongtae, K., Tachaudomdach, C., & Somrarnyart, M. (2021). Factors related to health-related quality of life among critically ill survivors. Nursing Journal, 48(1), 281-294. https://he02.tci-thaijo.org/index.php/cmunursing/article/view/250261 (in Thai)
Rabiee, A., Nikayin, S., Hashem, M. D., Huang, M., Dinglas, V. D., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016). Depressive symptoms after critical illness: A systematic review and meta-analysis. Critical Care Medicine, 44(9), 1744–1753. https://doi.org/10.1097/CCM.0000000000001811
Rai, R., Singh, R., Azim, A., Agarwal, A., Mishra, P., & K Singh, K. S. (2020). Impact of critical Illness on quality of life after intensive care unit discharge. Indian Journal of Critical Care Medicine, 24(5), 299–306. https://doi.org/10.5005/jp-journals-10071-23433
Society of Critical Care Medicine (SCCM). (2020). Critical care statistics. https://sccm.org/Communications/Critical-Care-Statistics
Stevenson, J. E., Colantuoni, E., Bienvenu, O. J., Sricharoenchai, T., Wozniak, A., Shanholtz, C., Mendez-Tellez, P. A., & Needham, D. M. (2013). General anxiety symptoms after acute lung injury: Predictors and correlates. Journal of Psychosomatic Research, 75(3), 287–293. https://doi.org/10.1016/j.jpsychores.2013.06.002
Su, M., Hua, X., Wang, J., Yao, N., Zhao, D., Liu, W., Zou, Y., Anderson, R., & Sun, X. (2019). Health-related quality of life among cancer survivors in rural China. Quality of Life Research, 28, 695–702. https://doi.org/10.1007/s11136-018-2038-6
Su, Y.-X., Xu, L., Gao, X.-J., Wang, Z.-Y., Lu, X., & Yin, C.-F. (2018). Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis. Chinese Journal of Traumatology, 21(4), 216–223. https://doi.org/10.1016/j.cjtee.2018.05.001
Teixeira, C., Rosa, R. G., Sganzerla, D., Sanchez, E. C., Robinson, C. C., Dietrich, C., Kochhann, R., de Souza, D., Rech, G. S., da R Dos Santos, R., Schneider, D., Boldo, R., Sharshar, T., Bozza, F. A., Falavigna, M., & Friedman, G. (2021). The burden of mental illness among survivors of critical care-risk factors and impact on quality of life: A multicenter prospective cohort study. Chest, 160(1), 157–164. https://doi.org/10.1016/j.chest.2021.02.034
Vest, M. T., Murphy, T. E., Araujo, K. L. B., & Pisani, M. A. (2011). Disability in activities of daily living, depression, and quality of life among older medical ICU survivors: A prospective cohort study. Health and Quality of Life Outcomes, 9, 9. https://doi.org/10.1186/1477-7525-9-9
Vogel, G., Forinder, U., Sandgren, A., Svensen, C., & Joelsson-Alm, E. (2018). Health-related quality of life after general surgical intensive care. Acta Anaesthe- siologica Scandinavica, 62(8), 1112–1119. https://doi.org/10.1111/aas.13139
Ware, J. E. Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.
Wieske, L., Dettling-Ihnenfeldt, D. S., Verhamme, C., Nollet, F., van Schaik, I. N., Schultz, M. J., Horn, J., & van der Schaaf, M. (2015). Impact of ICU-acquired weakness on post-ICU physical functioning: A follow-up study. Critical Care, 19(1), 196. https://doi.org/10.1186/s13054-015-0937-2
World Health Organization. (2012). WHOQOL: Measuring quality of life. https://www.who.int/tools/whoqol/whoqol-bref
Yi, Z., & Vaupel, J. W. (2002). Functional capacity and self–evaluation of health and life of oldest old in China. Journal of Social Issues, 58(4), 733-748.
Yi, Z., Vaupel, J. W., & Zhenyu, X. (2001). The Healthy Longevity Survey and the Active Life Expectancy of the Oldest Old in China. https://www.persee.fr/doc/pop_0032-4663_2001_hos_13_1_7232
Zeggwagh, A. A., Dendane, T., Abidi, K., Kettani, M. N., Iraqi, A., & Zeggwagh, Z. (2020). Health-related quality of life evaluated by MOS SF-36 in the elderly patients 1 month before ICU admission and 3 months after ICU discharge. Indian Journal of Critical Care Medicine, 24(7), 531–538. https://doi.org/10.5005/jp-journals-10071-23489
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Nursing Journal CMU
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารพยาบาลสาร
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับมหาวิทยาลัยเชียงใหม่ และคณาจารย์ท่านอื่นๆในมหาวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
