Skip to main content
    • Aa
    • Aa

Quality of life, emotional, and cognitive function following acute respiratory distress syndrome

  • RAMONA O. HOPKINS (a1) (a2), LINDELL K. WEAVER (a1) (a3), KAREN J. CHAN (a4) and JAMES F. ORME (a1) (a3)

Acute Respiratory Distress Syndrome (ARDS) is characterized by lung injury and hypoxemia, has a high mortality rate, and is associated with significant morbidity including cognitive and emotional sequelae and decreased quality of life. There is limited information regarding which of these factors are associated with decreased quality of life. This study assessed the relationships between quality of life, cognitive and emotional function in ARDS survivors at 1-year post-hospital discharge. Sixty-six ARDS survivors were administered a battery of neuropsychological tests, measures of emotional function and quality of life 1 year post-hospital discharge. At 1 year 45% of the ARDS patients had cognitive sequelae and 29% had mild to moderate symptoms of depression and anxiety. Depression, anxiety, and intensive care unit length of stay were significantly correlated with decreased quality of life. Cognitive impairments did not correlate with decreased quality of life. Illness severity and emotional function, but not cognitive sequelae, are associated with decreased quality of life 1 year following ARDS. ARDS is common and may result in significant cognitive and emotional morbidity and decreased quality of life. (JINS, 2004, 10, 1005–1017.)

Corresponding author
Reprint requests to: Ramona O. Hopkins, Ph.D., Psychology Department, 1122 SWKT, Brigham Young University, Provo, UT 84602. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Abel, S.J., Finney, S.J., Brett, S.J., Keogh, B.F., Morgan, C.J., & Evans, T.W. (1998). Reduced mortality in association with the acute respiratory distress syndrome (ARDS). Thorax, 53, 292294.

Albert, S.M., Michaels, K., Padilla, M., Pelton, G., Bell, K., Marder, K., Stern, Y., & Devanand, D.P. (1997). Functional significance of mild cognitive impairment in elderly patients without a dementia diagnosis. American Journal of Geriatric Psychiatry, 7, 213220.

Angus, D.C., Musthafa, A.A., Clermont, G., Griffin, M.F., Linde-Zwirble, W.T., Dremsizov, T., & Pinsky, M.R. (2001). Quality-adjusted survival in the first year after the acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 163, 13891394.

Bernard, G.R., Artigas, A., Brigham, K.L., Carlet, J., Falle, K., Hudson, L., Lamy, M., LeGall, J.R., Morris, A., & Spragg, R. (1994). Report of the American-European Consensus Conference on acute respiratory distress syndrome: Definitions, mechanics, relevant outcomes, and clinical trial coordination. American Journal of Respiratory Critical Care Medicine, 149, 818824.

Combes, A., Costa, M.A., Trouillet, J.L., Baudot, J., Mokhtari, M., Gibert, C., & Chastre, J. (2003). Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Critical Care Medicine, 31, 13731381.

Cooper, A.B., Ferguson, N.D., Hanly, P., Meade, M.O., Kachura, J.R., Granton, J.T., Slutsky, A.S., & Stewart, T.E. (1999). Long-term follow-up of survivors of acute lung injury: Lack of effect of a ventilation strategy to prevent barotrauma. Critical Care Medicine, 27, 26162621.

Craven, J.L., Rodin, G.M., & Littlefield, C. (1988). The Beck Depression Inventory as a screening device for major depression in renal dialysis patients. International Journal of Psychiatry Medicine, 18, 365374.

Davidson, T.A., Caldwell, E.S., Curtis, J.R., Hudson, L.D., & Steinberg, K.P. (1999). Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. Journal of the American Medical Association, 281, 354360.

Ely, E.W., Shintani, A., Truman, B., Speroff, T., Gordon, S.M., Harrell, F., Jr., Inouye, S.K., Bernard, G.R., & Dittus, R.S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of the American Medical Association, 291, 17531762.

Foa, E.B., Riggs, D.S., Dancu, C.V.S., & Rothbaum, B.O. (1993). Reliability and validity of a brief instrument for assessing Post Traumatic Stress Disorder. Journal of Traumatic Stress, 6, 459473.

Frasure-Smith, N., Lesperance, F., & Talajic, M. (1995). The impact of negative emotions on prognosis following myocardial infarction: Is it more than depression?Health Psychology, 14, 388398.

Gale, S.D. & Hopkins, R.O. (2004). Effects of hypoxia on the brain: Neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. Journal of the International Neuropsychological Society, 10, 6071.

Gold, P.W., Licinio, J., Wong, M.L., & Chrousos, G.P. (1995). Corticotropin releasing hormone in the pathophysiology of melancholic and atypical depression and in the mechanism of action of antidepressant drugs. Annals of the New York Academy of Sciences, 771, 716729.

Green, A., Felmingham, K., Baguley, I.J., Slewa-Younan, S., & Simpson, S. (2001). The clinical utility of the Beck Depression Inventory after traumatic brain injury. Brain Injury, 15, 10211028.

Griffith, H.R., Belue, K., Sicola, A., Krzywanski, S., Zamrini, E., Harrell, L., & Marson, D.C. (2003). Impaired financial abilities in mild cognitive impairment: A direct assessment approach. Neurology, 60, 449457.

Heaton, R.K., Temkin, N., Dikmen, S., Avitable, N., Taylor, M.J., Marcotte, T.D., & Grant, I. (2001). Detecting change: A comparison of three neuropsychological methods, using normal and clinical samples. Archives of Clinical Neuropsychology, 16, 7591.

Herridge, M.S., Cheung, A.M., Tansey, C.M., Matte-Martyn, A., Diaz-Granados, N., Al-Saidi, F., Cooper, A.B., Guest, C.B., Mazer, C.D., Mehta, S., Stewart, T.E., Barr, A., Cook, D., Slutsky, A.S., & the Canadian Critical Care Trials Group. (2003). One-year outcomes in survivors of the acute respiratory distress syndrome. New England Journal of Medicine, 348, 683693.

Heyland, D.K., Hopman, W., Coo, H., Tranmer, J., & McColl, M.A. (2000). Long-term health-related quality of life in survivors of sepsis. Short form 36: A valid and reliable measure of health-related quality of life. Critical Care Medicine, 28, 35993605.

Hopkins, R.O., Larson-Lohr, V., Weaver, L.K., & Bigler, E.D. (1998). Neuropsychological impairments following hantavirus pulmonary syndrome. Journal of the International Neuropsychological Society, 4, 190196.

Hopkins, R.O., Weaver, L.K., Pope, D., Orme, J.F., Bigler, E.D., & Larson, L.V. (1999). Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 160, 5056.

Jackson, J.C., Hart, R.P., Gordon, S.M., Shintani, A., Truman, B., May, L., & Ely, E.W. (2003). Six-month neuropsychological outcome of medical intensive care unit patients. Critical Care Medicine, 31, 12261234.

Kapfhammer, H.P., Rothenhausler, H.B., Krauseneck, T., Stoll, C., & Schelling, G. (2004). Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. American Journal of Psychiatry, 161, 4552.

Katz, I.R. (1982). Is there a hypoxic affective syndrome?Psychosomatics, 23, 846853.

Katz, I.R. (1996). On the inseparability of mental and physical health in aged persons: Lessons from depression and medical comorbidity. American Journal of Geriatric Psychiatry, 4, 116.

Knaus, W.A., Draper, E.A., Wagner, D.P., & Zimmerman, J.E. (1985). APACHE II: A severity of disease classification system. Critical Care Medicine, 13, 818829.

Kwa, V.I., Limburg, M., & de Haan, R.J. (1996a). The role of cognitive impairment in the quality of life after ischaemic stroke. Journal of Neurology, 243, 599604.

Kwa, V.I., Limburg, M., Voogel, A.J., Teunisse, S., Derix, M.M., & Hijdra, A. (1996b). Feasibility of cognitive screening of patients with ischaemic stroke using the CAMCOG. A hospital-based study. Journal of Neurology, 243, 405409.

McHugh, L.G., Milberg, J.A., Whitcomb, M.E., Schoene, R.B., Maunder, R.J., & Hudson, L.D. (1994). Recovery of function in survivors of the acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 150, 9094.

McSweeny, A.J., Grant, I., Heaton, R.K., Prigatano, G.P., & Adams, K. (1985). Relationship of neuropsychological status to everyday functioning in healthy and chronically ill persons. Journal of Clinical and Experimental Neuropsychology, 7, 281291.

Michaels, A.J., Michales, C.E., Smith, J.S., Moon, C.H., Peterson, C., & Long, W.B. (2000). PTSD in critical care. Journal of Trauma, 48, 841850.

Milberg, J.A., Davis, D.R., Steinberg, K.P., & Hudson, L.D. (1995). Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. Journal of the American Medical Association, 273, 306309.

Milisen, K., Foreman, M.D., Abraham, I.L., Geest, S.D., Bodderis, J., Vandermeulen, E., Fischler, B., Delooz, H.H., Spiessens, B., & Broos, P.L. (2001). A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. Journal of the American Geriatrics Society, 49, 523532.

Nelson, B.J., Weinert, C.R., Bury, C.L., Marinelli, W.A., & Gross, C.R. (2000). Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Critical Care Medicine, 28, 36263630.

Newman, M., Grocott, H., Mathew, J., White, W., Landolfo, K., Reves, J., (2001a). Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke, 32, 28742881.

Newman, M., Kirchner, J., Phillips-Bute, B., Gaver, V., Grocott, H., Jones, R.H., Mark, D.B., Reves, J.G., Blumenthal, J.A., & The Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. (2001b). Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. New England Journal of Medicine, 344, 395402.

Orme, J., Jr., Romney, J.S., Hopkins, R.O., Pope, D., Chan, K.J., Thomsen, G., Crapo, R.O., & Weaver, L.K. (2003). Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 167, 690694.

Osowiecki, D.M., Cohen, R.A., Morrow, K.M., Paul, R.H., Carpenter, C.C., Flanigan, T., & Boland, R.J. (2000). Neurocognitive and psychological contributions to quality of life in HIV-1-infected women. Aids, 14, 13271332.

Pearlson, G.D., Rabins, P.V., Kim, W.S., Speedie, L.J., Moberg, P.J., Burns, A., & Bascom, M.J. (1989). Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia (‘pseudodementia’). Psychological Medicine, 19, 573584.

Petty, T.L. & Ashbaugh, D.G. (1971). The adult respiratory distress syndrome: Clinical features and factors influencing prognosis and principles of management. Chest, 60, 233239.

Rincon, H.G., Granados, M., Unutzer, J., Gomez, M., Duran, R., Badiel, M., Salas, C., Martinez, J., Mejia, J., Ordonez, C., Florez, N., Rosso, F., & Echeverri, P. (2001). Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit. Psychosomatics, 42, 391396.

Rockwood, K., Brown, M., Merry, H., Sketris, I., & Fisk, J. (2002). Societal costs of vascular cognitive impairment in older adults. Stroke, 33, 16051609.

Rothenhausler, H.B., Ehrentraut, S., Stoll, C., Schelling, G., & Kapfhammer, H.P. (2001). The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: Results of an exploratory study. General Hospital Psychiatry, 23, 9096.

Rubenfeld, G.D., Doyle, R.L., & Matthay, M.A. (1995). Evaluation of definitions of ARDS. American Journal of Respiratory and Critical Care Medicine, 151, 12701271.

Schelling, G., Richter, M., Roozendaal, B., Rothenhausler, H.B., Krauseneck, T., Stoll, C., Nollert, G., Schmidt, M., & Kapfhammer, H.P. (2003). Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Critical Care Medicine, 31, 19711980.

Schelling, G., Stoll, C., Haller, M., Briegel, J., Manert, W., Hummel, T., Lenhart, A., Heyduck, M., Polaset, J., Meier, M., Preuss, U., Bullinger, M., Schuffel, W., & Peter, K. (1998). Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Critical Care Medicine, 26, 651659.

Scragg, P., Jones, A., & Fauvel, N. (2001). Psychological problems following ICU treatment. Anaesthesia, 56, 914.

Silverstone, P.H. (1996). Prevalence of psychiatric disorders in medical inpatients. Journal of Nervous and Mental Disease, 184, 4351.

Silverstone, P.H., Lemay, T., Elliott, J., Hsu, V., & Starko, R. (1996). The prevalence of major depressive disorder and low self-esteem in medical inpatients. Canadian Journal of Psychiatry, 41, 6774.

Stewart, A., Hays, R., & Ware, J. (1988). The MOS short form general health survey: Reliability and validity in a patient population. Medical Care, 26, 724732.

Streadman-Pare, D., Colantonio, A., Ratcliff, G., Chase, S., & Vernich, L. (2000). Factors associated with perceived quality of life many years after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16, 330342.

Suchyta, M.R., Clemmer, T., Orme, J.F., Jr., Morris, A.H., & Elliott, C.G. (1991). Increased survival of ARDS patients with severe hypoxemia (ECMO criteria). Chest, 99, 951955.

Suchyta, M.R., Elliott, C.G., Jensen, R.L., & Crapo, R.O. (1993). Predicting the presence of pulmonary function impairment in adult respiratory distress syndrome survivors. Respiration, 60, 103108.

Szokol, J.W. & Vender, J.S. (2001). Anxiety, delirium, and pain in the intensive care unit. Critical Care Clinics, 17, 821842.

Tabert, M.H., Albert, S.M., Borukhova-Milov, B.A., Camacho, Y., Pelton, G., Liu, X., Stern, Y., & Devanand, D.P. (2002). Functional deficits in patients with mild cognitive impairments: Prediction of AD. Neurology, 58, 758764.

Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: A comparison of four models. Journal of the International Neuropsychological Society, 5, 357369.

Thiagarajan, J. & Miranda, D.R. (1995). Quality of life after multiple trauma requiring intensive care. Anaesthesia, 49, 211218.

Toshima, M.T., Blumberg, E., Ries, A.L., & Kaplan, R.M. (1992). Does rehabilitation reduce depression in patients with chronic obstructive pulmonary disease?Journal of Cardiopulmonary Rehabilitation, 12, 261269.

Weaver, L.K., Hopkins, R.O., Chan, K.J., Churchill, S., Elliott, C.G., Clemmer, T.P., Orme, J.F., Jr., Thomas, F.O., & Morris, A.H. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347, 10571067.

Weinert, C.R., Gross, C.R., Kangas, J.R., Cury, C.L., & Marinelli, W.A. (1997). Health-related quality of life after acute lung injury. American Journal of Respiratory and Critical Care Medicine, 156, 11201128.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 4
Total number of PDF views: 36 *
Loading metrics...

Abstract views

Total abstract views: 138 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd May 2017. This data will be updated every 24 hours.