Abstract
Emotional distress, including anxiety and sadness, is common among patients in the intensive care unit (ICU). It may be influenced by clinical factors but also by physical distress symptoms such as dyspnea and pain; however, trajectories of emotional and physical distress and interactions throughout the ICU stay, and their potential impact after discharge, remain relatively unexplored. The main objective of the study was to investigate the trajectory and interplay of anxiety, sadness, dyspnea, and pain during the ICU stay, and also their associations with clinical and demographic factors and with cognitive status at discharge. Observational, longitudinal study in non-delirious adult ICU patients in whom emotional state (anxiety and sadness) and physical discomfort (dyspnea and pain) were assessed daily using a visual analog scale, once an adequate level of consciousness (RASS between − 1 and + 1) had been achieved. A new variable was created to compare the evolution of distress in the different phases of admission. Mixed-effects models were used to explore associations with the phase of ICU stay, invasive mechanical ventilation (IMV), and other clinical variables. Cognitive status was assessed at ICU discharge with the MoCA test. In 62 ICU patients, levels of sadness consistently exceeded anxiety during ICU stay, although both remained stable and declined only in the final phase. IMV was associated with higher levels of sadness (β = 2.45, p < 0.001) and dyspnea (β = 1.24, p = 0.003). Male patients reported lower anxiety levels (β = − 1.34, p = 0.039). Pain correlated with sadness early in the ICU period (r = 0.44, p = 0.016), and with dyspnea during the second (r = 0.54, p = 0.001) and late phases (r = 0.34, p = 0.004). At ICU discharge, 70.9% of patients showed cognitive impairment unrelated to distress, clinical or demographic variables. Sadness was identified as a more prominent component of emotional distress than anxiety during the ICU stay. The findings underscore the impact of IMV on both sadness and dyspnea, highlighting the value of a multidimensional psychological assessment in critically ill patients. The lack of association between cognitive impairment at discharge and in-ICU emotional/physical distress trajectories suggests that cognitive and emotional sequelae may arise from distinct underlying mechanisms.
Trial registration: ClinicalTrials.gov (NCT07153380).
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Data availability
The dataset generated and analyzed during the current study is available in the RDR (Research Data Repository), a federated and multidisciplinary repository for Catalan universities, CERCA research centers, and other research institutions. RDR complies with the FAIR principles (Findable, Accessible, Interoperable, and Reusable) and follows the EOSC (European Open Science Cloud) guidelines. RDR will comply with the FAIR principles (Findable, Accessible, Interoperable, and Reusable) and will follow the EOSC (European Open Science Cloud) guidelines. The datasets generated and analyzed during the current study are available in the Cora RDR (Research Data Repository), (https://doi.org/10.34810/data2719). The files are available upon request.
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Acknowledgements
The authors thank Michael Maudsley for his invaluable support in editing the manuscript. Special acknowledgements are due to all the patients who voluntarily agreed to participate in the study.
Funding
This work was supported by the Instituto de Salud Carlos III (ISCIII) under Grant number PI21/01592, La Marató 3CAT, under Grant numbers 202118 (413/C/2021) and 202214–30-31 (262/C/2022); CIBER -Consorcio Centro de Investigación Biomédica en Red- CB06/06/1097, ISCIII, Ministerio de Ciencia e Innovación and Unión Europea-European Regional Development Fund; CERCA Programme/Generalitat de Catalunya; and Fundació Institut d’Investigació i Innovació Parc Taulí-I3PT (CIR2017/032).
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EDL, MGG, AFO and SFG designed the study and the protocols. GG, JEE, CDH and EDS contributed in the sample recruitment and provided clinical expertise in designing the protocol. EDL, MGG, GNV, MJ and SFG provided psychological and neuropsychological advice in the design of the protocol. EDL, MGG, GNV and SFG performed the neuropsychological assessment. AFO, EDL and SFG performed the statistical analysis. EDL, SFG, LS, JLA and LB drafted the manuscript. All authors were involved in the interpretation of the results and approved the final version for publication.
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Data collection for each cohort was independently approved by the Institutional Review Board of the Parc Taulí University Hospital (2018/542, 2021/5088, 2022/6011). The reanalysis for the current project was approved. (2025/5057) and registered on ClinicalTrials.gov (NCT07153380) on September 3, 2025. All participants (or their authorized representatives) provided written informed consent prior to inclusion in the study.
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Doña-López, E., Godoy-González, M., Navarra-Ventura, G. et al. Trajectories of emotional and physical distress during ICU stay and their association with clinical factors and cognitive status at discharge. Sci Rep (2026). https://doi.org/10.1038/s41598-026-36684-y
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DOI: https://doi.org/10.1038/s41598-026-36684-y
