Objective: Acute lung injury (ALI), including its more severe subcategory, acute respiratory distress syndrome (ARDS), is a critical illness associated with considerable morbidity and mortality. Our objective was to summarize data on the prevalence of depressive, posttraumatic stress disorder (PTSD), and other anxiety syndromes amongst survivors of ALI/ARDS, potential risk factors for these syndromes, and their relationships to quality of life. Methods: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, and PsycINFO. Eligible studies reported data on psychiatric morbidity at least once after intensive care treatment of ALI/ARDS. Results: Ten observational studies met inclusion criteria (total n = 331). Using questionnaires, the point prevalence of “clinically significant” symptoms of depression ranged from 17% to 43% (4 studies); PTSD, 21% to 35% (4 studies); and nonspecific anxiety, 23% to 48% (3 studies). Studies varied in terms of instruments used, thresholds for clinical significance, baseline psychiatric history exclusions, and timing of assessments (range = 1 month to 8 years). Psychiatrist-diagnosed PTSD prevalence at hospital discharge, 5 years, and 8 years were 44%, 25%, and 24%, respectively. Three studies prospectively assessed risk factors for post-ALI/ARDS PTSD and depressive symptoms; significant predictors included longer durations of mechanical ventilation, intensive care unit stay, and sedation. All four studies that examined relationships between psychiatric symptoms and quality of life found significant negative associations. Conclusions: The prevalence of psychiatric morbidity in patients surviving ARDS seems high. Future research should incorporate more in-depth diagnostic and risk factor assessments for prevention and monitoring purposes. ALI = acute lung injury; ARDS = acute respiratory distress syndrome; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CES-D = Center for Epidemiologic Studies Depression scale; GABA = γ-aminobutyric acid; ICU = intensive care unit; IES = Impact of Events Scale; LOS = length of stay; MADRS = Montgomery-Asberg Depression Rating Scale; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; PTSS-10 = Posttraumatic Symptom Scale-10; QOL = quality of life; SCID = Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition); SCL90r = Symptom Checklist 90r; SF-36 = Medical Outcomes Study Short Form-36; SIP = Sickness Impact Profile; STAS-S = Spielberger State-Trait Anxiety Scale-State.

Diabetes mellitus (DM) and major depression are very common in Western populations. Type 2 DM occurs in approximately 8% to 14% of most Western populations,¹ whereas approximately 25% of women and 16% of men will have a major depressive episode during their lifetime.² Quiz Ref ID As many as 20% of persons with type 2 DM have comorbid depression.³ Furthermore, a recent meta-analysis has established a bidirectional link between depression and DM.⁴ Patients with comorbid depression and DM have poorer adherence to diet, smoking cessation, exercise, and medication regimens to control DM.⁵ Depression is also associated with increased cortisol levels,⁶ autonomic nervous system dysregulation,⁷ and increased inflammation,⁸ all of which worsen glycemic control. Therefore, patients with comorbid depression and DM have an increased risk for microvascular and macrovascular complications and mortality.⁹