Long-term psychological disorders in children after intensive care unit admission: a population-based study

Abstract Background Pediatric intensive care unit (PICU) survivors face significant psychological sequelae beyond physical recovery. This study aimed to characterize age-related differences in first recorded psychological and neurodevelopmental diagnoses among children who survived ICU admission. Methods This nationwide cohort study analyzed the Korean National Health Insurance Service database from 2015 to 2019. Patients were stratified into three groups: young children (< 6 years), school-aged (≥ 6 to < 13 years), and adolescents (≥ 13 to < 18 years). Fine–Gray subdistribution hazard models accounting for death as a competing risk were used to assess risks of depression, anxiety disorders, post-traumatic stress disorder (PTSD), and neurodevelopmental disorders over a follow-up period of up to 8.63 years. Results Adolescents demonstrated significantly higher risks for depression (adjusted subdistribution hazard ratio [aSHR] 13.81, 95% confidence interval [CI] 11.45–16.66), anxiety disorders (aSHR 5.50, 95% CI 4.79–6.33), and PTSD (aSHR 6.39, 95% CI 5.00–8.18) compared with young children. Conversely, young children had higher rates of recorded neurodevelopmental disorders, particularly language developmental disorders (aSHR 0.07, 95% CI 0.04–0.13 for adolescents vs. young children) and autism spectrum disorders (aSHR 0.17, 95% CI 0.12–0.26 for adolescents vs. young children). Attention deficit hyperactivity disorder (ADHD) risk showed no significant age-dependent variation. Conclusions These age-dependent patterns suggest that post-discharge psychological follow-up after pediatric ICU admission may benefit from an age-stratified approach that pairs neurodevelopmental surveillance in younger children with mood-disorder screening in adolescents. Clinical trial number Not applicable.