Psychiatric symptoms in patients with lung cancer following postoperative acute respiratory distress syndrome

Abstract

BACKGROUND

Patients with acute respiratory distress syndrome (ARDS) after lung cancer surgery experience critical illness, prolonged hospitalization, and intensive monitoring, resulting in substantial physical and psychological stress. The actual psychological and sleep data of lung cancer patients with postoperative ARDS after discharge are still limited, and further clinical evidence is needed to clarify the anxiety, depression, and sleep disorders of this high-risk population. Current clinical management prioritizes respiratory support and multi-organ function preservation; however, structured evidence regarding post-discharge anxiety, depression, and sleep disturbance remains insufficient.

AIM

To investigate the distribution of anxiety, depression, and sleep disturbance within one month after discharge in patients with lung cancer complicated by postoperative ARDS and to explore associated clinical factors.

METHODS

This was a retrospective observational study. A total of 200 patients with ARDS after lung cancer surgery who were treated from January 2024 to December 2025 were included. Clinical data were collected from medical records, nursing records, intensive care unit (ICU) monitoring data, and one-month postdischarge follow-up assessments. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and sleep disturbance was assessed using the Pittsburgh Sleep Quality Index. Delirium was defined as at least one positive Confusion Assessment Method for the ICU assessment during ICU stay. Baseline Hospital Anxiety and Depression Scale/Pittsburgh Sleep Quality Index scores were unavailable; therefore, outcomes were interpreted as postdischarge symptom positivity rather than confirmed new-onset morbidity.

RESULTS

In a retrospective cohort of 200 patients, 43 (21.50%) had anxiety symptoms, 36 (18.00%) had depressive symptoms, 71 (35.50%) had sleep disturbances, and 113 (56.50%) had at least one psychological sleep outcome. The proportions of composite outcomes in mild, moderate, and severe ARDS were 43.53%, 61.33%, and 75.00%, respectively (χ² = 10.432, P = 0.005). Multivariable logistic regression analysis for the composite outcome showed associations with female sex [odds ratio (OR) = 2.525, 95% confidence interval (CI): 1.284-4.964, P = 0.007], severe ARDS (OR = 3.481, 95%CI: 1.356-8.938, P = 0.010), thoracotomy (OR = 2.289, 95%CI: 1.098-4.773, P = 0.027), and postoperative delirium (OR = 2.330, 95%CI: 1.048-5.181, P = 0.038). Exploratory outcome-specific models suggested that sleep disturbances were mainly associated with severe ARDS, thoracotomy, pain, prolonged ventilation, and delirium, whereas anxiety and depression showed partially different patterns.

CONCLUSION

In this retrospective cohort, sleep disturbance was the most frequent postdischarge abnormality after postoperative ARDS in patients with lung cancer. These findings should be interpreted as exploratory findings rather than causal clinical evidence. Strengthened sleep and mood screening, standardized delirium documentation, and prospective longitudinal studies with baseline psychological and sleep assessments are recommended.

Keywords: Lung cancer; Acute respiratory distress syndrome; Anxiety; Depression; Sleep disturbance; Retrospective cohort analysis; Retrospective observational study

Core Tip: This retrospective observational study explored anxiety, depression, and sleep disturbance after postoperative acute respiratory distress syndrome in patients with lung cancer. Sleep disturbance was the most frequent outcome and appeared to drive many of the composite psychological-sleep endpoints. Female sex, severe acute respiratory distress syndrome, thoracotomy, and postoperative delirium were associated with the composite endpoint, whereas outcome-specific analyses suggested different patterns of anxiety, depression, and sleep disturbance. The findings support standardized screening and prospective validation rather than direct causal inference.