Leiden University Student Repository

Herk, Janique van (2026)

Depression, Fatigue, and Chronic Pain Interference in ICU Survivors: A Mediation Analysis

Master thesis | Psychology (MSc)

Many intensive care unit (ICU) survivors experience long term physical and psychological symptoms that interfere with daily functioning. Chronic pain, fatigue, and depression are common symptoms in post-intensive care syndrome (PICS). These symptoms often co-occur but their interrelations are not clearly documented. Depression and chronic pain often co-exist, and depressive symptoms possibly lead to an increase in experienced pain. Fatigue is a common symptom of PICS as well, which could influence depression and pain. The first question this study focused on is whether depressive symptoms are associated with greater chronic pain interference in daily life one year after ICU discharge, and the second question was concerned with whether fatigue mediated this relationship. Data were obtained from the CONTENT-ICU study at the Leiden University Medical Center (LUMC), including 412 ICU survivors aged 18 years and older. Participants completed questionnaires assessing depressive symptoms ...Show moreMany intensive care unit (ICU) survivors experience long term physical and psychological symptoms that interfere with daily functioning. Chronic pain, fatigue, and depression are common symptoms in post-intensive care syndrome (PICS). These symptoms often co-occur but their interrelations are not clearly documented. Depression and chronic pain often co-exist, and depressive symptoms possibly lead to an increase in experienced pain. Fatigue is a common symptom of PICS as well, which could influence depression and pain. The first question this study focused on is whether depressive symptoms are associated with greater chronic pain interference in daily life one year after ICU discharge, and the second question was concerned with whether fatigue mediated this relationship. Data were obtained from the CONTENT-ICU study at the Leiden University Medical Center (LUMC), including 412 ICU survivors aged 18 years and older. Participants completed questionnaires assessing depressive symptoms (Patient Health Questionnaire – PHQ-9), fatigue (four custom numeric rating scale items), and pain interference (Brief Pain Inventory – BPI). Linear regression and mediation analyses were used to answer the research questions of this study. Higher levels of depressive symptoms were significantly associated with greater chronic pain interference (p <.001). Fatigue partly mediated the association between depressive symptoms and pain interference (B = 0.09, 95% CI [0.05, 0.13]). These findings suggest that emotional distress could contribute to physical limitations, partly through increased exhaustion. This indicates the need for early screening and treatment of depressive symptoms in ICU survivors – which may improve patients’ mood but also lessen fatigue, which can lead to less pain interference. The results highlight the interconnected nature of PICS symptoms and underscore the importance of multidimensional post-ICU rehabilitation.Show less

Post-Intensive Care Syndrome

intensive care unit survivors

depressive symptoms

chronic pain interference

fatigue

mediation

Author

Herk, Janique van

Faculty

Faculty of Social & Behavioural Sciences

Specialisation

Health and Medical Psychology

Supervisors

Veldhuijzen, D.S.

ECTS Credits

20

Language

nl