Association between isolation room admission in intensive care units and long-term psychiatric disorders: a nationwide cohort study

Crit Care. 2025 Nov 29. doi: 10.1186/s13054-025-05770-4. Online ahead of print.

ABSTRACT

BACKGROUND: Whether admission to a single-bed intensive care unit (ICU) isolation room is associated with subsequent psychiatric morbidity remains uncertain. We investigated the association between ICU isolation and new-onset psychiatric disorders after discharge.

METHODS: Using South Korea’s National Health Insurance Service database, we conducted a nationwide retrospective cohort study including adults admitted to any ICU between Jan 1 2020 and Dec 31 2022. We excluded patients < 18 years, those who died within 1 year, and those with psychiatric diagnoses in the preceding 12 months. Outcomes were new diagnoses of depression, anxiety disorder, or post-traumatic stress disorder (PTSD) within 1 year after ICU admission. Exposure was any stay in a single-bed ICU isolation room; isolation duration (days) was also analyzed.

RESULTS: Among 517 917 ICU survivors, 136 172 (26.3%) developed a psychiatric disorder within 1 year (depression 15.6%, anxiety 16.8%, PTSD 0.1%). Admission to an ICU isolation room was modestly associated with any psychiatric disorder (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06; P = 0.034). This association was primarily driven by depression (OR, 1.06; 95% CI, 1.03-1.10; P < 0.001). There were no significant associations with anxiety disorder (P = 0.64) or PTSD (P = 0.307). When treating the duration of ICU isolation as a continuous variable, each additional day of isolation showed a small incremental association with psychiatric disorder (OR per day, 1.01; 95% CI, 1.01-1.01; P < 0.001) and depression (OR, 1.01; 95% CI, 1.01-1.02; P < 0.001).

CONCLUSIONS: ICU admission to a single-bed isolation room showed a small yet consistent association with post-ICU psychiatric morbidity, mainly depression. Given the minimal absolute difference and observational design, causality cannot be inferred. Nevertheless, isolation represents a potentially modifiable environmental exposure that warrants further confirmatory and mechanistic research, as well as pragmatic evaluation of mitigation strategies such as improved communication, family engagement, and circadian cueing.

PMID:41318624 | DOI:10.1186/s13054-025-05770-4